||Use this form for employee enrollment additions or changes.
|Statement of Claim
||Use this form for submitting claims to Health Cost Solutions.
|Request for Confidential Communications
||Use this form to request alternate or confidential communications.
|Request for Restrictions on Use or Disclosure of Protected Health Information
||For use to request a restriction on the use or disclosure of health information.
|Request for an Accounting of Certain Disclosures of Health Information
||For requesting an accounting of certain disclosures of protected health information.
|Request for Amendment of Protected Health Information
||Use this form to request the addition of information to your health information.
|Request for Access to Protected Health Information
||To request access or copies of Protected Health Information
|FSA Dependent Care Reimbursement Form
|Use this form to submit eligible dependent care expenses for reimbursment.
|FSA Health Care Expenses Reimbursement Form
|Use this form to submit health care expenses for reimbursment.