• Forms

Questions about your plan? Call us.
Click here to see the documents and forms for Idaho.

Individual Member Forms

Small Employer Forms

Large Employer

HIPUtah and Federal-HIPUtah Forms

Disclosure Authorization Form

Pharmacy Forms

Application for Extension of Dependent Coverage

Medical Claim Reimbursement Form


Online Payment Instructions

  • Online Premium Payment Instructions - Utah
  • Online Premium Payment Instructions - Idaho
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