Forms Directory
See below for a general list of forms that can be downloaded or printed. Please use the filter buttons to help search for a specific form by category. Some forms may only be found behind your secure participant login. Click the blue "Showing __ Results" text at the top of the directory to see more forms.
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Elixir Designation of Personal Representative (Spanish)
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Elixir Drug Reimbursement Claim Form
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Elixir Mail Service Brochure
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UEBT Extended Death Benefit Filing Requirements
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UCBT Extended Death Benefit Filing Requirements
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UEBT Active Extended Medical Benefits
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UCBT Extended Medical Benefits (Active)
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Kaiser/Kaiser Dual Reimbursement Form
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UEBT Elixir Market Price Drug Exception Request
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Notice of Return from Armed Forces
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Prudential - Notice of Conversion Privilege Form
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Authorization to Disclose Specific Protected Health Information (PHI)