Click on the appropriate form you require and it will open up in any web browser.  Just print it out, mail or fax it in as stated on the form.

• COBRA Account Change Form
  
  
• COBRA Appeal Form
  
  
• HIPAA Authorization/Disclosure of Protected Health Information
  
  
• HIPAA Revocation Authorization/ Disclosure of Protected Health Information

For COBRA enrolled participants who would like to print a premium payment coupon, please click here to log into your account.

To view and print the forms, you need the Adobe Acrobat Reader installed on your computer. Adobe Acrobat Reader is free and can be run as an independent program or as a "plug-in" for most major web browsers to allow on-line viewing of PDF documents.

To download the Reader click on the "Get Adobe Reader" link below. This will take you to Adobe Systems' website. Follow the detailed instructions on the Adobe website to download and then install the software on your computer.