You are here: Human Resources / Benefits
Residents and Clinical Fellows: Forms
- Beneficiary Form for Sun Life Insurance
-
Blue Cross Claim Form
/
-
Blue Cross Mail Service Prescription Drug Program Form
/
-
Blue Cross Prescription Drug Form
/
-
Declaration of Domestic Partnership Form
/
-
Declaration of Tax Dependency and Declaration of Registration of Domestic Partnership in CA, 2007
/
-
Declination of Coverage
/
-
Delta Dental and Blue Cross Enrollment Form (UniCare) - COBRA
/
Please use this form for enrolling in COBRA for Delta Dental and/or Blue Cross only. Once completed please mail to the address on the form. Please also fax a copy to Tony Wagner at the insurance desk, 476-4449.
-
Health Net Claim Form
/
-
Health Net Insurance Enrollment Form - COBRA
/
-
Health Net Prescription Claim Form
/
- Insurance Action Form
- Sun Life Disability Claim Form - Coordinator Completes
- Sun Life Disability Claim Form - Trainee Completes
- Sun Life Disability Physician Statement - Trainee Sends to Physician
-
Vision Service Plan Enrollment Form - COBRA
/