{"id":498,"date":"2017-08-15T21:01:48","date_gmt":"2017-08-15T21:01:48","guid":{"rendered":"http:\/\/mybenefitscc.wpengine.com\/cmcrescue\/?page_id=498"},"modified":"2025-12-10T18:01:54","modified_gmt":"2025-12-10T18:01:54","slug":"forms","status":"publish","type":"page","link":"https:\/\/mybenefits.cc\/gordonprill26\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;section&#8221; _builder_version=&#8221;4.16&#8243; transparent_background=&#8221;off&#8221; padding_mobile=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row column_padding_mobile=&#8221;on&#8221; admin_label=&#8221;row&#8221; _builder_version=&#8221;4.21.0&#8243; background_enable_color=&#8221;off&#8221; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; custom_padding=&#8221;|13px||13px||true&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text admin_label=&#8221;Forms&#8221; _builder_version=&#8221;4.16&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; use_border_color=&#8221;off&#8221; border_color=&#8221;#ffffff&#8221; border_style=&#8221;solid&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3>Forms<\/h3>\n<p>[\/et_pb_text][et_pb_tabs admin_label=&#8221;Coverage Tabs&#8221; _builder_version=&#8221;4.27.4&#8243; hover_enabled=&#8221;0&#8243; use_border_color=&#8221;on&#8221; saved_tabs=&#8221;all&#8221; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;][et_pb_tab title=&#8221;Medical Forms&#8221; _builder_version=&#8221;4.24.2&#8243; global_colors_info=&#8221;{}&#8221;]<a href=\"https:\/\/acribenefits.com\/data1\/dnload\/uhc\/claim.pdf\">UHC Medical Claim Form<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/dnload\/uhc\/rxclaim.pdf\">UHC Pharmacy Reimbursement Claim Form<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/dnload\/uhc\/rxclaimmail.pdf\">UHC Mail Order Pharmacy Reimbursement Claim Form<\/a><\/p>\n<p><a href=\"https:\/\/acribenefits.com\/data1\/dnload\/kaiser\/claimform.pdf\">Kaiser Claim Form<\/a>[\/et_pb_tab][et_pb_tab title=&#8221;HSA Forms&#8221; _builder_version=&#8221;4.24.2&#8243; global_colors_info=&#8221;{}&#8221;]<a href=\"https:\/\/acribenefits.com\/data1\/gordonprill\/hsaded.pdf\">HSA Contribution Payroll Deduction Election 2017<\/a>[\/et_pb_tab][et_pb_tab title=&#8221;Dental Forms&#8221; _builder_version=&#8221;4.24.2&#8243; global_colors_info=&#8221;{}&#8221;]<a href=\"https:\/\/acribenefits.com\/data1\/dnload\/mutualofomaha\/dentalclaim.pdf\">Mutual of Omaha Dental Claim Form<\/a>[\/et_pb_tab][et_pb_tab title=&#8221;Life &#038; Disability Forms&#8221; _builder_version=&#8221;4.27.4&#8243; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<p><a href=\"https:\/\/acribenefits.com\/data1\/dnload\/mutualofomaha\/2023-life-claim-form.pdf\">Mutual of Omaha Life Claim Form<\/a><br \/><a href=\"https:\/\/acribenefits.com\/data1\/dnload\/mutualofomaha\/how-file-life-claim.pdf\">Mutual of Omaha: How to File a Life Claim<\/a><\/p>\n<p><a href=\"https:\/\/acribenefits.com\/data1\/dnload\/mutualofomaha\/bendes.pdf\">Mutual of Omaha Beneficiary Designation Form<\/a><br \/><a href=\"https:\/\/acribenefits.com\/data1\/dnload\/mutualofomaha\/ben-assistance.pdf\">Mutual of Omaha Beneficiary Assistance<\/a><\/p>\n<p><a href=\"https:\/\/acribenefits.com\/data1\/gordonprill\/2023\/moo-portability-conversion.pdf\">Mutual of Omaha Portability vs Conversion<\/a><br \/><a href=\"https:\/\/acribenefits.com\/data1\/gordonprill\/2023\/moo-portability-form.pdf\">Mutual of Omaha Life Portability Form<\/a><br \/><a href=\"https:\/\/acribenefits.com\/data1\/gordonprill\/2023\/moo-conversion-form.pdf\">Mutual of Omaha Life Conversion Form<\/a><\/p>\n<p>[\/et_pb_tab][et_pb_tab title=&#8221;FSA Forms&#8221; 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