Forms

Need to make a change to your election, or notify your employer, and PHBP, of a qualifying event? You'll find any and all forms related to administrative changes here.

  2013 Prescription Information and Mail Order Form

  COBRA Qualiyfing Event Notification

  Enrollment/Change Form - Option 1 Medical Only

  Enrollment/Change Form - Option 2 Medical, Dental and Vision

  Employee Verification Change Form

  Joint Affidavit of Opposite Sex Domestic Partnership

  Joint Affidavit of Same Sex Domestic Partnership

  PHBP electronic consent of plan and health communications

  2017 Anthem Claim Form