PDF Downloads

Download common PDF forms for dental claims, health insurance, and more.

2022 Formulary OptumRX
January2022_B2C_Premium_Standard_Formulary_Booklet.pdf
2022 July Formulary OptumRx
July 2022 OptumRx Formulary.pdf
2022 Wellness Form
Wellness Physician Form 2022.pdf
2023 Formulary OptumRx
2023 Optum Formulary.pdf
Dental Claim Form
DENTAL CLAIM FORM.pdf
HUMANA Enrollment Information
2023 HUMANA eKit Local 66 Welfare Fund Age.pdf
Member Reimbursement Benefit Form
Member Reimbursement Form.pdf
National Vision Associates - Reimbursement Form
NVA Direct Reimbursement.pdf
Optum Reimbursement Form
Optum Reimbursement Form.pdf
OptumRx Physician Form
OptumRx Physician Form.pdf
© 2022 Operating Engineers Local 66 Combined Funds Inc.