{"id":36,"date":"2019-05-23T20:39:21","date_gmt":"2019-05-23T20:39:21","guid":{"rendered":"https:\/\/mybenefits.cc\/jireh\/?page_id=36"},"modified":"2025-02-03T23:24:41","modified_gmt":"2025-02-03T23:24:41","slug":"forms","status":"publish","type":"page","link":"https:\/\/mybenefits.cc\/jireh\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"

[et_pb_section fb_built=”1″ custom_padding_last_edited=”on|desktop” admin_label=”section” _builder_version=”4.16″ background_enable_color=”off” background_image=”https:\/\/mybenefits.cc\/jireh\/wp-content\/uploads\/sites\/3563\/2020\/04\/bg-inner.jpg” min_height=”622px” custom_padding_tablet=”50px|0|50px|0″ custom_padding_phone=”” transparent_background=”off” padding_mobile=”off” global_colors_info=”{}”][et_pb_row column_padding_mobile=”on” admin_label=”row” _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” custom_padding=”0|0px|27px|0px|false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_button button_text=”Forms” _builder_version=”4.16″ custom_button=”on” button_text_size=”22px” button_text_color=”#ffffff” button_bg_use_color_gradient=”on” button_bg_color_gradient_stops=”#0264c1 0%|#0f8bdd 100%” button_bg_color_gradient_start=”#0264c1″ button_bg_color_gradient_end=”#0f8bdd” button_border_color=”rgba(0,0,0,0)” global_colors_info=”{}”][\/et_pb_button][et_pb_tabs active_tab_background_color=”#002f59″ inactive_tab_background_color=”#0f8bdd” active_tab_text_color=”#ffffff” admin_label=”Coverage Tabs” _builder_version=”4.27.4″ tab_text_color=”#ffffff” tab_font_size=”13px” background_size=”initial” background_position=”top_left” background_repeat=”repeat” hover_enabled=”0″ border_color_all=”#d8d8d8″ use_border_color=”on” saved_tabs=”all” global_colors_info=”{}” sticky_enabled=”0″][et_pb_tab title=”Medical Forms” _builder_version=”4.24.2″ body_font=”||||” body_line_height=”2em” tab_font=”||||” tab_line_height=”2em” body_line_height_tablet=”2em” body_line_height_phone=”2em” tab_line_height_tablet=”2em” tab_line_height_phone=”2em” global_colors_info=”{}”]United Healthcare Medical Enrollment \/ Waiver Form<\/a>
\nUnited Healthcare Medical Change Form<\/a>
\nUnited Healthcare Claim Form<\/a>
\nUnited Healthcare Pharmacy Reimbursement Claim Form<\/a>
\nUnited Healthcare Mail Order Pharmacy Reimbursement Claim Form<\/a><\/p>\n

Kaiser Enrollment Form<\/a>
\nKaiser Change Form<\/a>
\nKaiser COBRA Form<\/a>
\nKaiser Claim Form<\/a>
\nKaiser Student Certification Form<\/a>
\nKaiser Termination Form<\/a>
\nKaiser Declination of Coverage Form<\/a><\/p>\n

Authorization for Release of Information<\/a>[\/et_pb_tab][et_pb_tab title=”Dental Forms” _builder_version=”4.27.2″ body_font=”||||” body_line_height=”2em” tab_font=”||||” tab_line_height=”2em” body_line_height_tablet=”2em” body_line_height_phone=”2em” tab_line_height_tablet=”2em” tab_line_height_phone=”2em” global_colors_info=”{}”]<\/p>\n

Coming Soon<\/p>\n

[\/et_pb_tab][et_pb_tab title=”Vision Forms” _builder_version=”4.24.2″ body_font=”||||” body_line_height=”2em” tab_font=”||||” tab_line_height=”2em” body_line_height_tablet=”2em” body_line_height_phone=”2em” tab_line_height_tablet=”2em” tab_line_height_phone=”2em” global_colors_info=”{}”]VSP Vision Claim Form<\/a>[\/et_pb_tab][et_pb_tab title=”Life & Disability” _builder_version=”4.27.4″ _module_preset=”default” hover_enabled=”0″ sticky_enabled=”0″]<\/p>\n

Reliance Matrix Conversion Form<\/a>
Reliance Matrix Portability Form<\/a><\/p>\n

[\/et_pb_tab][et_pb_tab title=”Flex \/ Section 125 Forms” _builder_version=”4.24.2″ body_font=”||||” body_line_height=”2em” tab_font=”||||” tab_line_height=”2em” body_line_height_tablet=”2em” body_line_height_phone=”2em” tab_line_height_tablet=”2em” tab_line_height_phone=”2em” global_colors_info=”{}”]Flex Plan Claim Form<\/a>[\/et_pb_tab][\/et_pb_tabs][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"

United Healthcare Medical Enrollment \/ Waiver Form United Healthcare Medical Change Form United Healthcare Claim Form United Healthcare Pharmacy Reimbursement Claim Form United Healthcare Mail Order Pharmacy Reimbursement Claim Form Kaiser Enrollment Form Kaiser Change Form Kaiser COBRA Form Kaiser Claim Form Kaiser Student Certification Form Kaiser Termination Form Kaiser Declination of Coverage Form Authorization […]<\/p>\n","protected":false},"author":765,"featured_media":0,"parent":0,"menu_order":8,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-36","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/mybenefits.cc\/jireh\/wp-json\/wp\/v2\/pages\/36","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mybenefits.cc\/jireh\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mybenefits.cc\/jireh\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mybenefits.cc\/jireh\/wp-json\/wp\/v2\/users\/765"}],"replies":[{"embeddable":true,"href":"https:\/\/mybenefits.cc\/jireh\/wp-json\/wp\/v2\/comments?post=36"}],"version-history":[{"count":0,"href":"https:\/\/mybenefits.cc\/jireh\/wp-json\/wp\/v2\/pages\/36\/revisions"}],"wp:attachment":[{"href":"https:\/\/mybenefits.cc\/jireh\/wp-json\/wp\/v2\/media?parent=36"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}