Forms & Resources

Medical Request Form - Newborn to 2 Months (PDF)

Medical Request Form - Age 3 to 25 Months (PDF)

Medical Request Form - Age 40 and Older (PDF)

Traditional Plan Comparison Grid (PDF)

Major Medical Plan - Schedule of Benefits (PDF)

High Deductible Health Plan - Schedule of Benefits (PDF)

Dental/Vision - Schedule of Benefits (PDF)

Classic Choice - Schedule of Benefits (PDF)

Advanced Choice - Schedule of Benefits (PDF)

UMR Medical Claim Submission Form (PDF)

AHP Prescription Reimbursement Form

Request for Reconsideration of Declined Coverage

Request for Reconsideration of Rate

Request for Reconsideration of Rider

Request for Reconsideration of Tobacco Rate

AHP Personal Representative Designation (PDF)

AHP Bank Draft Authorization Form (PDF)

AHP Coverage Cancellation Form (PDF)

AHP Payor Authorization Revoked Form (PDF)

AHP Alternative Plan Selection - Transfer - Change Form (PDF)

AHP Grievance Form

Grievance Procedures

Initial Payments Instruction