​Forms

• Biometric Screening Form

• Change of Address Form (English)

• HIPAA Authorization Form

​Resources

• Progyny Member Guide

​Resources

• EyeMed Benefit Summary (English)

• EyeMed Benefit Summary (Spanish)

​Forms (English)

• Employee Accident & Sickness Disability Claim Form

• Physician Accident & Sickness Disability Claim Form

 

Forms (Spanish)

• Employee Accident & Sickness Disability Claim Form

• Physician Accident & Sickness Disability Claim Form

​Forms

• Dental Change Form

 

Resources

• Dental Providers Booklet

• Dental Primary Fee Schedule

• Dental Specialist Fee Schedule

​Resources

• OptumRx Formulary

​Forms

• Education Reimbursement

​Forms

• Preventive Wellness Reimbursement Form

​Forms

• Physical Well-Being Benefit Direct Reimbursement Form

Forms

• Prescription Incentive Program Claim Form

​Resources

• ACME Hours Calendar

• Citterio Summary of Benefits and Coverage