Forms/Resources
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Enrollment and Coverage Changes
If you are not enrolled in the Health Options Program: Application Form (PDF 97K)
If you are enrolled in the Health Options Program and looking to change your coverage: Change Form (PDF 108K)
Claims
Health Options Program Major Medical Claim Form (PDF 280K)
Health Options Program (MetLife) Dental Claim Form (PDF 675K)
Submit EyeMed (vision) claims through the online claim form or by logging in to the member area of the EyeMed website.
Prescription Drug Plan Forms
Health Options Program (OptumRx) Prescription Drug Claim Form (PDF 457K)
Health Options Program (OptumRx) Prescription Drug Prior Authorization Form (PDF 310K)
Health Options Program (OptumRx) Prescription Drug Mail Service Pharmacy Order Form (PDF 496K)
CMS Appointment of Representative Form (Form CMS-1696) (PDF 73K)
Last modified 2023-01-19