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1. Plan Change Form State Employee IB14 - Alabama - Insurance

2. MedImpact Prior Authorization Request Form - Alabama - Insurance

3. Non-Tobacco User Discount Application IB05 - Alabama - Insurance

4. Provider Screening Form IB13 - Alabama - Insurance

5. Request for Reimbursement Form for Flexible Health Care Account - Alabama - Insurance

6. Revoke Election Form IB09 - Alabama - Insurance

7. Refund Request IB10 - Alabama - Insurance

8. WC Assessment Form WCC10 - Alabama - Insurance

9. Federal Poverty Level Discount (FPL) Application - Alabama - Insurance

10. COBRA Form 11 IB11 - Alabama - Insurance

11. MedImpact Prescription Drug Claim Form - Alabama - Insurance

12. Retiree Employment Verification IB16 - Alabama - Insurance

13. Retiree Re-Employed Form - Alabama - Insurance

14. Health Insurance Enrollment IB02 - New employees only - Alabama - Insurance

15. Southland National Vision Claim Form - Alabama - Insurance

16. Retiree Enrollment Form IB04 - Alabama - Insurance

17. Wellness Discount Certification Form IB07 - Alabama - Insurance

18. Request for Reimbursement Form for Flexible Dependent Care Account - Alabama - Insurance

19. Retiree Years of Service Verification IB18 - Alabama - Insurance

20. Annual Tobacco User Premium Discount Application IB06 - Alabama - Insurance