INTEGRIS BENEFITS

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Documents and forms


​2021 Forms
  • Dependent Verification Form - Spouse​
  • Dependent Verification Form - Child
  • Spouse Employment Verification Form - Surcharge
  • Out of State Dependent Proof of Residency Form
  • ​Common Law Marriage Affidavit
  • Dependent Disability Affidavit
  • 2021 Summary Plan Description
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2021 Summary Plan Description
(Benefits Handbook)
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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​
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2020 Forms​
  • Dependent Verification Form - Spouse​
  • Dependent Verification Form - Child
  • Spouse Employment Verification Form - Surcharge
  • Out of State Dependent Proof of Residency Form
  • ​Common Law Marriage Affidavit
  • Dependent Disability Affidavit
  • ​Medical Claim Form
  • Mail Order Prescription Drug Form​​
  • HIPAA Privacy Notice​
  • 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