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Forms & MRF Files

Claim Forms

Local 95 Medical Claim Form

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Vision Claim Form

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Dental Claim Form

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Medical Claim Form

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Enrollment Forms

Open the enrollment form below, download it and save it to your computer. Once saved, open that file, fill in all necessary fields, save the completed form again and attach and email it to the IDA Enrollment Department.

Enrollment Change Summary

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Standard Enrollment Form

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OptumRx Forms

FAQ's

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Home Delivery Prescription Form

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ID Card

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Claim Reimbursement Form

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Member Services

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Mobile App

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IDA Announcement About OptumRx

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Express Scripts Forms

Mail Order Instructions

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Mail Order Form

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Online with Express Scripts

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Getting Started with Express Scripts

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ProAct Forms

ProAct Pharm Services Order Form Request

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ProAct Direct Member Reimbursement Form

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ProAct How to Create an Online Account

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ProAct Online Resources

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ProAct Member Guide

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Miscellaneous Forms

Attending Physicians Statement

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Protected Health Information Authorization Form

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Regulatory Forms

CHIPRA Notice

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The Consolidated Appropriations Act of 2021 (CAA), also called the “No Surprises Act.”

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HIPAA Simple Notice

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New Health Insurance Marketplace Coverage -Exchange Notice

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Teladoc Forms

Teladoc New Registration

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EmpiRx Forms

Mail Order Pharmacy

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Pharmacy Benefit FAQ

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Care Management FAQ

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Member Portal

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EmpiRX Group Specific Forms:

Sam Coraluzzo Plan Guide

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Township of Wayne Plan Guide

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Cigna Forms & Programs

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Behavior Health

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Preventive Care

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Substance Abuse Evernorth

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Save on Radiology

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Save on Labs

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Medical Supplies Home Delivery

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Know Your Plan

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Home Health Services and Supplies-

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Hearing Aid Program

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Vaccine Program Participating Pharmacies

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Flu Shots

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Cost & Quality

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Care & Equipment

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Ask & Save

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Active & Fit Q&A

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Active & Fit Healthy Rewards

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Healthy Rewards

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Cigna Dental

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MyCigna Mobile

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MyCigna Online

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Find Behavior Health Provider

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Find a Provider

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Find a Provider Cigna.com

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Provider Recruitment Flyer

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CignaRx - Cigna Pharmacy Service Center

Prescription Drug Claim Form

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Aetna Programs

Video - The Brightline Experience: What are the benefits of teletherapy?

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Video - The Brightline Experience: How is coaching different than therapy?

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Video - The Brightline Experience: What's Different about Brightline's Care Model?

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Video - The Brightline Experience: Build for kids and teens, here for you (short)

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Video - The Brightline Experience: Build for kids and teens, here for you

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Brightline Videos

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Mobile Registration Instructions

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How to Get Started

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Here's What's Covered

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Get to Know Brightline

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Pediatric Behavioral Health

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Announcing Brightline Behavior Health Program

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Phoenix Rx PBM

Prescription Claim Reimbursement Form

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Prescription Home Delivery - Magnolia Pharmacy

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LifeMart Wellness Discounts

LifeMart Wellness Discounts

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LifeMart Member Flyer

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