Forms
When submitting a form to the III-A that has personal information, please request a secure email from [email protected] or fax to 208-575-6423. Must have Adobe Reader.
Agency Forms
| Employee Forms Procedure | Download Now |
| Employee Enrollment Form | Download Now |
| Employee Change Form | Download Now |
| Employee Termination Form | Download Now |
| Employee Declination of Coverage Form | Download Now |
| OneAmerica Life Insurance Beneficiary Form | Download Now |
Member Forms
| III-A Claims Form | Download Now |
| III-A Claims Form – Specialty Programs | Download Now |
| Inpatient Behavioral Health Program Form | Download Now |
| BCI Member Claim Form | Download Now |
| Coordination of Benefits Form | Download Now |
| Disabled Member Form | Download Now |
Acupuncture Provider Form
| Acupuncture Claim Form | Download Now |
EAP Provider Form
| III-A EAP Claim Form | Download Now |
| Vendor Payment Form | Download Now |
