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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Death Beneficiary Designation Change Form
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Overage Disabled Dependent Child Medical Benefits Application
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UEBT Retiree Dependent Documentation Requirements
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Domestic Partner Declaration of Dependency for Tax Purposes
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Elixir Compound Drug Prior Authorization
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Elixir Designation of Personal Representative (English)
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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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UEBT Active Extended Medical Benefits
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Kaiser/Kaiser Dual Reimbursement Form