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Useful Employer Forms

Here are some forms that you might find useful.

USNow Change Form

This form is required in order to process any changes to your employee’s records.   This includes:

  • Changes to address, name, phone
  • Request a new ID card or Fulfillment
  • Cancellations, Terminations and Additions
Please download, complete and fax this form to
214-291-8930 at least 10-days prior to the requested effective date.

 MSL DI Claim Form

Member Service Life Short-Term Disability Claim Form

MWG Dental Claim Form

Morgan White Dental Claim Form

Member Health Prescription Authorization Form

MemberHealth Prior Authorization Form for prescriptions requiring pre-approval

Member Health Prescription Reimbursement Form

MemberHealth Prescription Drug Program Direct Reimbursement Form

RxEDO Prescription Reimbursement Form

RxEDO Prescription Drug Program Direct Reimbursement Form
 HIPAA Authorization FormUSNow HIPAA Authorization Form
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