Forms and information

Accident form
Appeal request form
Authorization for release of protected health information (PHI)
Community resources
- Medicaid information (November 2020)
- Southern Nevada Medicaid plans comparison (November 2020)
- Federally Qualified Health Centers in Southern Nevada (November 2020)
- Nevada food banks (April 2022)
Continuity of care request form
Disenrollment form
How to sign up for the Participant Portal
Life insurance beneficiary form
Loss of time (LOT) form and checklist
Medical/vision claim form
Medicare Part D notice
Open enrollment form
Open enrollment packet
Participant Guide
Private health survey
Retiree enrollment application
Self-pay
Summary Annual Report (SAR)
Summary of Benefits and Coverage (SBC)
Summary Plan Description (SPD)
Tax information
Womenʼs Breast Cancer Annual Notice
Your Rights and Protections Against Surprise Medical Bills