Forms Online Access

The forms listed below can be downloaded and printed by selecting the corresponding link.

Claim Forms

Health Benefits Claim Form		Overseas Medical Claim Form
Health Benefits Claim Form - Spanish		Overseas Medical Claim Form - Spanish
Dental Benefits Claim Form		FEP Retail Prescription Drug Overseas Claim Form
Retail Pharmacy Claim Form		FEP Retail Prescription Drug Overseas Claim Form - Spanish
Retail Pharmacy Claim Form - Spanish

Retail Pharmacy Prior Approval Forms

FOR STANDARD AND BASIC OPTIONS: To determine which drugs require prior approval forms and to download and print the form(s) click here.