Forms

Downloadable Forms

Several forms are available in PDF format for downloading and printing. Click the links below to view each of the available forms. You will need Adobe Acrobat Reader  to view forms online.

 

Click on the Icon to download and Install Adobe Acrobat Reader.

APS Newsletter
Quarterly newsletter "Balance" distributed from APS Healthcare Keeping Healthy together.

Enrollment Card
Print and complete both sides of the form to enroll in the Plan.

Change of Eligibility Form Instructions
To add dependents to your Health plan follow these instructions.

Health Claim Form
Print this form out and submit with any health claims.

Dental Claim Form
You only need to submit this form if you visit an out-of-network dentist.

Student Enrollment Form
To be submitted annually to the Fund Office to continue coverage for students age 19-23

Cobra Continuation Election Form
We must receive this form within 60 days of eligibility.

Retiree Health Plan Application
Upon retirement all participants must elect to continue their coverage.