Forms

Eligibility Forms for All Plans:

Appeal Forms:

Consumer Driven Health Plan Forms:

Flexible Spending Account Forms:

Health Plan of Nevada (HPN) Forms:

Premier Plan (EPO) Forms:

Low Deductible Plan Forms:

Basic Life Insurance Forms:

United Healthcare is the plan administrator for the basic life insurance policy provided to eligible active and retired members effective 7/1/2022. For basic life insurance death claims where the participant was deceased prior to 7/1/2022 contact The Standard—Customer Service: 1-888-288-1270.

The Standard Insurance Forms for Voluntary Life Insurance:

PEBP Vaccine Clinic Consent Form: