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Health Care
Mail-Order Pharmacy Enrollment/Order Form (Elixir)
Medical/Dental Claim Form (also includes vision claims incurred through the end of 2023)
Prescription Drug Claim Form (Elixir)
Preauthorization Request/Approval Form
Health Plan Appeal Request Form/Claims Appeal Procedure
Formulary Exception Request Form
Flexible Spending Accounts
Accessing Your Navia Benefits Website
Life Insurance
Life Insurance Calculator (xls)
Optional Life Insurance Worksheet (pdf)
Statement of Health Form - MetLife
MIB Statement of Health Form - MetLife
Portability Election Form - MetLife
Family & Medical Leave (FMLA)
FMLA Certification for Serious Injury or Illness of Covered Veteran - for Military Family Leave
FMLA Certification of Health Care Provider for Employee's Serious Health Condition
FMLA Certification of Health Care Provider for Family Member's Serious Health Condition
FMLA Certification of Qualifying Exigency for Military Family Leave