Forms

Forms

Several forms are available in PDF format for downloading and printing. Click the links below to view each of the available forms.

You will need Adobe Acrobat Reader to view forms online.

Davis Vision Direct Reimbursement Claim Form

Blue Cross Subscriber Claim Form

Blue Cross Drug Claim Form

Blue Cross Mail Service and Form

Dental Blue Claim Form

Envision Rx Option Reimbursement Form

Fitness Benefit

Weight Loss Benefit

Teamsters Local 170 Health & Welfare Fund Participant Authorization Form
(HIPAA Authorization Form)