Forms and Links

Please select the form/link that you may need from the lists below.  For questions, please email humanresources@una.edu.

  • Accident Policy Wellness Claim Form
  • Accident Policy Cancer Screening Wellness Benefit Claim Form
  • Accident Policy Claim Form
  • Cancer/Intensive Care Claim Form (PIC)
  • Cancer/Specified Disease Claim Form (Allstate)
  • Cancer Wellness Claim Form (Allstate)
  • Hospital Insurance Sickness Claim Form
  • Medical Expense Claim Form
  • Prescription Claim Form
  • Prescription Claim Online Submission Link
  • Vision Claim Form
  • Air Evac Application
  • Beneficiary Form
  • Benefit Eligibility Chart
  • BCBS Open Enrollment - 2019
  • Blue Cross/Blue Shield Website
  • Cafeteria Plan Form
  • Employee Accident/Injury Report
  • FMLA Healthcare Provider Certification Form
  • Marketplace Notification - 2019

Benefits

Handbook / Policies