Forms

If you are an active employee or retiree, please log on to your E-PEBP Portal for detailed information including Plan Year 2020 documents, new voluntary product information, to enroll/make changes, or to access your HealthScope or Express Scripts single sign on accounts.

Eligibility Forms for All Plans:

• PY 2020 Insurance Marketplace Coverage Options for Eligible New Hires
• PY 2020 Insurance Marketplace Coverage Options for Ineligible New Hires
• Release of Information Authorization

Public Records Request Forms:

• Public Records Request
• Public Records Request Form
• Public Records Request Initial Receipt Response
• Fee Schedule for Public Records Requests