{"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":"2024-03-07T01:12:27","modified_gmt":"2024-03-07T01:12:27","slug":"forms","status":"publish","type":"page","link":"https:\/\/mybenefits.cc\/partnership\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|desktop&#8221; admin_label=&#8221;section&#8221; _builder_version=&#8221;4.16&#8243; background_color=&#8221;#ededed&#8221; custom_padding_tablet=&#8221;50px|0|50px|0&#8243; custom_padding_phone=&#8221;&#8221; transparent_background=&#8221;off&#8221; padding_mobile=&#8221;off&#8221; make_fullwidth=&#8221;off&#8221; use_custom_width=&#8221;off&#8221; width_unit=&#8221;on&#8221; custom_width_px=&#8221;1080px&#8221; custom_width_percent=&#8221;80%&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row padding_mobile=&#8221;off&#8221; column_padding_mobile=&#8221;on&#8221; admin_label=&#8221;row&#8221; _builder_version=&#8221;4.16&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; make_fullwidth=&#8221;off&#8221; use_custom_width=&#8221;off&#8221; width_unit=&#8221;off&#8221; custom_width_px=&#8221;1080px&#8221; custom_width_percent=&#8221;80%&#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 active_tab_background_color=&#8221;#19a3dd&#8221; admin_label=&#8221;Coverage Tabs&#8221; _builder_version=&#8221;4.24.2&#8243; tab_font_size=&#8221;12&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; hover_enabled=&#8221;0&#8243; border_color_all=&#8221;#d8d8d8&#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; body_font=&#8221;||||&#8221; body_line_height=&#8221;2em&#8221; tab_font=&#8221;||||&#8221; tab_line_height=&#8221;2em&#8221; hover_enabled=&#8221;0&#8243; body_line_height_tablet=&#8221;2em&#8221; body_line_height_phone=&#8221;2em&#8221; tab_line_height_tablet=&#8221;2em&#8221; tab_line_height_phone=&#8221;2em&#8221; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<a href=\"https:\/\/acribenefits.com\/data1\/dnload\/blueshield\/bsclaimform-bsl&amp;h.pdf\">Blue Shield Medical Claim Form<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/partnership\/2022\/blueshield-prescription-reimbursement-claim-form.pdf\">Blue Shield Prescription Claim Form<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/partnership\/2022\/cvs-caremark-mail-service-order-form.pdf\">Blue Shield Mail Order Prescription 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;Dental Forms&#8221; _builder_version=&#8221;4.24.2&#8243; body_font=&#8221;||||&#8221; body_line_height=&#8221;2em&#8221; tab_font=&#8221;||||&#8221; tab_line_height=&#8221;2em&#8221; hover_enabled=&#8221;0&#8243; body_line_height_tablet=&#8221;2em&#8221; body_line_height_phone=&#8221;2em&#8221; tab_line_height_tablet=&#8221;2em&#8221; tab_line_height_phone=&#8221;2em&#8221; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<a href=\"https:\/\/acribenefits.com\/data1\/partnership\/2022\/direct-dental-reimbursement-form.pdf\">Direct Dental Claim Form<\/a>[\/et_pb_tab][et_pb_tab title=&#8221;Vision Forms&#8221; _builder_version=&#8221;4.24.2&#8243; body_font=&#8221;||||&#8221; body_line_height=&#8221;2em&#8221; tab_font=&#8221;||||&#8221; tab_line_height=&#8221;2em&#8221; hover_enabled=&#8221;0&#8243; body_line_height_tablet=&#8221;2em&#8221; body_line_height_phone=&#8221;2em&#8221; tab_line_height_tablet=&#8221;2em&#8221; tab_line_height_phone=&#8221;2em&#8221; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<a href=\"https:\/\/acribenefits.com\/data1\/dnload\/vsp\/claimform.pdf\">VSP Vision Claim Form<\/a>[\/et_pb_tab][et_pb_tab title=&#8221;Life &#038; Disability Forms&#8221; _builder_version=&#8221;4.24.2&#8243; body_font=&#8221;||||&#8221; body_line_height=&#8221;2em&#8221; tab_font=&#8221;||||&#8221; tab_line_height=&#8221;2em&#8221; hover_enabled=&#8221;0&#8243; body_line_height_tablet=&#8221;2em&#8221; body_line_height_phone=&#8221;2em&#8221; tab_line_height_tablet=&#8221;2em&#8221; tab_line_height_phone=&#8221;2em&#8221; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<a href=\"https:\/\/acribenefits.com\/data1\/dnload\/mutualofomaha\/stdclaim.pdf\" target=\"new\" rel=\"noopener noreferrer\">Mutual of Omaha Short Term Disability Claim Form<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/dnload\/mutualofomaha\/ltdclaim.pdf\" target=\"new\" rel=\"noopener noreferrer\">Mutual of Omaha Long Term Disability Claim Form<\/a>[\/et_pb_tab][et_pb_tab title=&#8221;HSA Forms&#8221; 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