Forms
415
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Agency Forms

Employee Forms Procedure

 

Employee Enrollment Form

Employee Change Form

Employee Termination Form

Employee Declination of Coverage Form

OneAmerica Life Insurance Beneficiary Form *effective 10/1/2020

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.

EAP Provider Form

III-A EAP Claim Form

Member Forms

Employee Enrollment Form

III-A Claims Form

Employee Change Form

BCI Member Claim Form

Coordination of Benefits Form

Disabled Member Form

Members: Turn in your updated/completed forms to your clerk/HR Department.