DVHIT Forms

Forms - Medical, Dental, Vision, Pharmacy

Medical and/or Dental Enrollment Form (New form effective 8/20/10 - combines medical and dental)

Aetna Medical Benefits Claim Form

Delta Dental Claim Form

Request for Dependent Handicap Status

Vision Benefits Claim Form

Vision Reimbursement Instructions

Prescription Drug Reimbursement Form

RX Home Delivery (New Form Effective October 15, 2011)

COBRA

COBRA Qualifying Event Form

Private Health Information Notice and Forms

DVHIT Privacy Notice

HIPAA Form  - Authorization of Release Private Health Information

Privacy Practices and Rights

Member Wellness Initative Information and Forms

Member Wellness Initiative (member log in required)