General documents

• Group Benefit Program 2010
• 2010 Rates

Plan change request forms

• ACH Funds Transfer Form
• Termination of Benefits or Employment Form
• Waiver of Health Insurance Form
• Health Insurance Addition Form
• Retiree Dependent Addition Form
• Single to Family Dependent Addition Form
• Spouse or Dependent Termination Form
• Student or Newborn Dependent Addition Form
• Transfer of Benefits Form
• Life Insurance Beneficiary Update Form

To obtain an application, please contact Bethany Benefit Service for an enrollment packet.

Claim forms

• Highmark BCBS Medical Claim Form
• Highmark BCBS Medical International Claim Form
• Delta Dental Claim Form
• TruAssure Vision Claim Form
• Express Scripts Prescription Claim Form
• Express Scripts Prescription International Claim Form

Benefits information

• Highmark BCBS Program Books
• Delta Dental Schedule of Benefits
• TruAssure Vision Schedule of Benefits
• Unum Life Insurance Schedule of Benefits
• 2010 Preventative Health Schedule
• Medicare Formulary Description
• 2010 Prescription Drug Formulary