Health Options Program Application/Change Form (PDF 666K) (If you accidentally select an option and cannot change your selection, simply close the tab and click this link again to open a new blank form.)
Rx Reimbursement Form (PDF 121K)
Mail Service Prescription Order Form (PDF 497K)
MetLife Dental Claim Form (PDF 675K)
Notice of Non-Discrimination and Language Assistance (PDF 590K) A notice describing PSERS' non-discrimination policies and information on where to get language translation assistance for reviewing Health Options Program materials.
Last modified December 15, 2016