Documents and Forms - INTEGRIS Benefits

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Documents and Forms
Benefits Q&A
Medical
Dental
Vision
Life/Accident/Disability
Retirement
Discounts
Employee Assistance Program
More Benefits
2020 Open Enrollment
Dependent Audit FAQ's

Home
Documents and Forms
Benefits Q&A
Medical
Dental
Vision
Life/Accident/Disability
Retirement
Discounts
Employee Assistance Program
More Benefits
2020 Open Enrollment
Dependent Audit FAQ's

Documents and forms

2020 Documents and Links

2019 All Cost Sheets
2019 Benefits at a Glance
2019 Rates
2019 Summary Plan Description
2 019 Metro and Enid - Summary of Benefits and Coverage
2019 Regional - Summary of Benefits and Coverage
2019 Out of State Dependent - Summary of Benefits and Coverage
2019 INTEGRIS Formulary
2019 INTEGRIS PDL
2019 INTEGRIS Formulary Drug Exclusions
2019 Pharmacy Plan Detail
2019 How To Use The ConnectYourCare Employee Portal

2020 Forms

2019 Medical Claim Form
Mail Order Prescription Drug Form
Life Event Form
Common Law Marriage Affidavit
Dependent Disability Affidavit
Benefits Appeal Form
HIPAA Privacy Notice
Dependent Verification Form - Spouse
Spouse Other Benefits Authorization Form Surcharge
Dependent Verification Form - Child
Out of State Dependent Proof of Residency Form
2019 How To File A Claim With ConnectYourCare