Forms

• Address Change and Other Address/Addressee Information (PDF)

• Group Life Insurance Program
  
• Retirem​ent System

• State of Illinois Commuter Signup
• Employee FAQ
• Lost Product Claim Form
• Direct Pay Instructions
• Parking Voucher Instructions
• Prepaid Card Park Instructions
• Transit Pass Instructions

• Delta Dental of Illinois Claim form (PDF)

Members may also file their claims online at Online DCAP/MCAP Claim Form.

• MCAP Continuation Election Form
• MCAP Claim Form
• DCAP Claim Form
• Optum Financial FSA Reference Guide

• Aetna Cl​aim Form
• Blue Cross/Blue Shield Claim Form
• Blue Cross/Blue Shield International Claim Form
• HealthLink Claim Form

• Investing Opportunities for-your-HSA
• Optum Financial - Investing with your HSA
• Optum Account Refund Form
• Optum Financial Fee Schedule
• Optum HSA Beneficiary Form
• Optum HSA Claim Form
• Optum HSA Contribution Form
• Optum HSA Excess Contribution Removal Form

•  Leave of Absence Waiver (PDF)

• Life Insurance Certificate
  
  • Actively at Work
  • Annuitants
  • Survivors
• MetLife Financial Beneficiary Form
• MetLife Conversion and Portability Application
• MetLife Statement of Health Application

The following forms only apply to plan participants enrolled in HealthLink OAP, Coventry Health Care OAP or the Quality Care Health Plan

• CVS Caremark® Mail Service Order Form (PDF)
• CVS Caremark® Mail Service Order Form - Spanish (PDF)
• CVS Caremark® Paper Claim Form (PDF)
• CVS Caremark® Paper Claim Form - Spanish (PDF)

• EyeMed Claim Form (PDF)