Forms
Claim Form: Used by you or your doctor, to submit a claim for benefits or a prescription drug reimbursement (for those policies
which have MEDCO Rx Discount Program).
MEDCO Claim Form: Used for reimbursement of prescription drugs for those policies using the MEDCO network of pharmacies.
Specific Case Authorization Form: This form gives us permission to discuss a specific medical condition you might have with a designated person of your choice.
Yearly Authorization Form: This form gives us permission to discuss any and all medical conditions you might have with a designated person of your choice, throughout the school year.
Privacy Notice: This form gives you information on how we handle and protect your privacy regarding any medical condition.
Travel Assistance: This brochure gives you information you need to access our Travel Assistance Services when you travel. | 
