Agency Forms

Employee Forms Procedure

 

Employee Enrollment Form

Employee Change Form

Employee Termination Form

Employee Declination of Coverage Form

OneAmerica Life Insurance Beneficiary Form

EAP Provider Form

III-A EAP Claim Form

Acupuncture Provider Form

Acupuncture Claim Form

When submitting a form to the III-A that has personal information, please request a secure email from admin@iii-a.org or fax to 208-575-6423.  Must have Adobe Reader.

Member Forms

Employee Enrollment Form (turn in to your Clerk/HR)

III-A Claims Form

Employee Change Form (turn in to your Clerk/HR)

BCI Member Claim Form

Coordination of Benefits Form 

Disabled Member Form