You will need Adobe Acrobat to open these documents. If you do not have Acrobat Reader, you can download it from Adobe.com for free.

• Vision Claim Form (pdf)
• Maternity Claim Form (pdf)
• Dental Claim Form (pdf) - for non-HealthPlex Dentist
• Medical Reimbursement Form (pdf) - Form can be changed to reflect new year.
• Hospital Income Benefit Plan (pdf)
• Annual Scholarship Program Application
• Change of address - See your delegate for the green card or email us to request one to be sent to your home.