Click on the icon next to a form or document to view, print or download. Note below that the services provided by acupuncturists, chiropractors and naturopaths listed in the provider directory are not covered benefits for EUTF Participants under the EUTF PPO option. These documents are in Adobe PDF format. If you have problems viewing these documents, you may need to download and install the free Acrobat reader from Adobe. You can download this program here.
ACTIVE Members
RETIREE Members
Other Plan Forms
AKAMAI Way Poster
Coordination of Benefits Questionnaire
HIPAA Authorized Representative Form
Open Enrollment Letter
Prior Authorization List
Pior Authorization Form
Provider Directory
Provider Nomination Form
Transition of Care Form
Treatment Plan