Business Forms and Templates

This form is used for requesting reimbursement for out-of-network vision expenses with VSP insurance in California.

This document is used for requesting approval for medications that are not included in the preferred formulary of Blue Cross Blue Shield of Western New York.

This form is used for requesting prior authorization for HMG step therapy through Express Scripts.

This form is used for obtaining prior authorization for step therapy through Express Scripts. Step therapy is a cost-saving measure that requires patients to try lower-cost medications before progressing to more expensive options.

This form is used for submitting a direct reimbursement claim for FEP BlueVision in New York.

This form is used to file a health and wellness screening claim with Colonial Life in the state of South Carolina.

This form is used for terminating or transferring a Kaiser Permanente health insurance subscription.

This Form is used for requesting prior authorization of benefits for Actiq (Transmucosal Fentanyl Citrate) under Medicare Part D through Express Scripts.

This Form is used for requesting prior authorization of benefits for Vivitrol, a medication for alcohol and opioid dependence. It is an extended-release injectable form of naltrexone.

This form is used for Boy Scouts of America members to apply for money-earning activities.

This form is used for changing the beneficiary for a Colonial Life insurance policy in South Carolina.

This Form is used for filing an expedited pre-service clinical appeal with Bluecross Blueshield of Montana in Montana. It allows individuals to appeal a denial or restriction of coverage for medical services before receiving care.

This document is an application form for financial assistance for a summer camp program for the Boy Scouts of America in Mecklenburg County, North Carolina. It is used to request funds to help cover the cost of camp fees for eligible individuals.

This form is used for requesting prior authorization or step therapy exception for prescription drugs through Express Scripts.

This form is used for gathering information about a condominium project. It is required by Freddie Mac (also known as Fannie Mae) for loan approval.

This Form is used for reviewing the certification of homeowners' association for obtaining prior approval from Wells Fargo bank.

This Form is used for requesting photocopies of money orders sent through MoneyGram.

This Form is used for appealing a provider's request to Bluecross Blueshield of Texas in the state of Texas.

This form is used for confirming eligibility for TRICARE benefits.

This form is used for filing a claim for death benefits with Metlife insurance company. It is specifically designed for dependents of the deceased policyholder to claim the benefits.