Documents and Forms

2021 Open Enrollment
COVID-19 Info
Medical
Documents and Forms
Dental
Vision
Life/Accident/Disability
Retirement
Employee Assistance Program
More Benefits
Discounts
Benefits Q&A

2021 Open Enrollment
COVID-19 Info
Medical
Documents and Forms
Dental
Vision
Life/Accident/Disability
Retirement
Employee Assistance Program
More Benefits
Discounts
Benefits Q&A

Documents and forms

2020 Documents and Links

Benefits at a Glance
2020 Severance Policy
2020 SMM Severance Plan
2020 Summary Plan Description
2020 Metro and Enid - Summary of Benefits and Coverage
2020 Regional - Summary of Benefits and Coverage
2020 Out of State Dependent - Summary of Benefits and Coverage
2020 - Summary of Benefits and Coverage
2020 INTEGRIS Formulary
2020 INTEGRIS PDL
2020 INTEGRIS Formulary Drug Exclusions
2020 Pharmacy Plan Detail
2020 How To Use The ConnectYourCare Employee Portal

2020 Forms

Medical Claim Form
Mail Order Prescription Drug Form
Common Law Marriage Affidavit
Dependent Disability Affidavit
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
Caregiver Reduction in Hours Form
Caregiver Increase in Hours Form
How To File A Claim With ConnectYourCare
ConnectYourCare Healthcare Reimbursement Claim Form
ConnectYourCare Dependent Care Reimbursement Claim Form