Forms & MRF Files
Claim Forms
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.
OptumRx Forms
Express Scripts Forms
ProAct Forms
Miscellaneous Forms
Regulatory Forms
EmpiRx Forms
Cigna Forms & Programs
CignaRx - Cigna Pharmacy Service Center
If a member fills a script and pays out-of-pocket while the eligibility is being loaded with Cigna, please have the member complete the below and return it along with a copy of their pharmacy receipt to the address on page 2 and a reimbursement will be issued.