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Forms

Health Options Program Application/Change Form (PDF 148K) (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.)

Health Options Program Major Medical Claim Form (PDF 36K)

Rx Reimbursement Form (PDF 121K)

Rx Prior Authorization Form

Mail Service Prescription Order Form (PDF 497K)

MetLife Dental Claim Form (PDF 675K)

CMS’ Appointment of Representative Form (Form CMS-1696) (PDF 67K)