1581. MedImpact Prior Authorization Request Form - Alabama
INSTRUCTIONS: MEDIMPACT MEDICATION REQUEST FORM Alabama physicians and providers who need to treat a public employee enrolled in the state's PEEHIP program with a Prior Authorization drug must file the document discussed ...
1582. MedImpact Prescription Drug Claim Form - Alabama
INSTRUCTIONS: MEDIMPACT PRESCRIPTION DRUG CLAIM FORM Alabama public employees enrolled in the PEEHIP health insurance program use the prescription drug claim form discussed in this article to obtain coverage for their prescription ...
1583. Southland National Indemnity and Cancer Claim Form - Alabama
INSTRUCTIONS: SOUTHLAND NATIONAL INDEMNITY AND CANCER CLAIM FORM Alabama public employees who are treated in a hospital or for cancer use the claim form discussed in this article to file a claim for coverage with Southland Benefits ...
1584. Southland National Dental Claim Form - Alabama
INSTRUCTIONS: SOUTHLAND DENTAL CLAIM FORM Alabama public employees who have dental insurance from Southland Benefit Solutions use the dental claim form discussed in this article after having a dental appointment. This document can ...
1585. Southland National Vision Claim Form - Alabama
INSTRUCTIONS: SOUTHLAND VISION CLAIM FORM Alabama public employees who are enrolled with Southland Benefit Solutions health insurance use the vision claim form discussed in this article to file for coverage for a vision health appo ...
1586. Health Insurance and Optional Status Change - Alabama
INSTRUCTIONS: ALABAMA HEALTH INSURANCE AND OPTIONAL STATUS CHANGE Alabama public education employees who are already enrolled in the state insurance program known as PEEHIP can use the form discussed in this article to make changes ...
1587. Health Insurance and Optional Enrollment Application - Alabama
INSTRUCTIONS: ALABAMA HEALTH INSURANCE AND OPTIONAL ENROLLMENT APPLICATION Alabama public education employees who wish to enroll in the state's health insurance plan known as PEEHIP do so using the form discussed in this articl ...
1588. Monthly Member Contribution Remittance - Salary - Alabama
INSTRUCTIONS: ALABAMA MONTHLY MEMBER CONTRIBUTION REMITTANCE PROBATE JUDGES ON SALARY Probate judges paid on a salary basis who are members of the Judicial Retirement Fund are required to contribute 6% of their annual co ...
1589. Monthly Member Contribution Remittance - Fee - Alabama
INSTRUCTIONS: ALABAMA MONTHLY MEMBER CONTRIBUTION REMITTANCE PROBATE JUDGES ON FEE Alabama probate judges who are paid on a fee basis are required to submit the remittance form discussed in this article before or on the first day o ...
1590. Application of Surviving Spouse for Retirement Benefits - Alabama
INSTRUCTIONS: ALABAMA APPLICATION OF SURVIVING SPOUSE FOR RETIREMENT BENEFITS Surviving spouses of Alabama judicial employees who have died can file the document discussed in this article to request that they be granted benefits fr ...