Click the health and welfare forms below to download and print them from your computer. You will need Adobe Acrobat Reader, a free download. [1]
| File | Description | |
|---|---|---|
 [1] | Dental form [1] | |
| [1] | Optical Program [1] | |
| [1] | Statement of Disability [1] | A two-page form. First page is for member's completion and the second page is for doctor's to complete. |
| [1] | SUBROGATION FORM/INJURY INQUIRY [1] | SUBROGATION FORM/INJURY INQUIRY |
| Attachment | Size |
|---|---|
| MEDCO DIRECT_COB FORM.pdf [2] | 131.29 KB |
| STOP AND SHOP ELECTION FORM.pdf [3] | 92.63 KB |