Clients & Members
Download the PDF forms below or request hard copies.
Claim Forms
- BT-AS-A Accident & sickness (PDF)
- BT-MM-A Medical Standard (PDF)
- BT-DE-A Dental Standard (PDF)
- BT-SD-A Suppl Disability (PDF)
- BT-DD-A Direct Deposit (PDF)
Administrative Forms
- BT-CR-A Change of Record (PDF)
- BT-TR-A Termination – Rehire (PDF)
- BT-DAT-A Decl Appointing Trustee (PDF)
- BT-EF-A Enrollment Standard (PDF)
- BT-OAD-A Overage Dependent (PDF)
- Pre-Authorized Payment (PDF)