2281. MedImpact Medication Request Form - Alabama

  INSTRUCTIONS: ALABAMA MEDICATION REQUEST FORM (MRF)     Participating physicians and providers treating an Alabama public employee and obtaining coverage for a Prior Authorization drug for which there is no available suitabl ...

2282. Form 10_2011 MedImpact Prescription Drug Claim Form - Alabama

  INSTRUCTIONS: ALABAMA PRESCRIPTION DRUG CLAIM FORM (Form 10_2011)     To process claims for prescription drugs for Alabama public employees enrolled in coverage administered by Medimpact, use the claim form discussed in this ...

2283. Southland Benefit Solutions Employee's Statement - Alabama

  INSTRUCTIONS: ALABAMA SOUTHLAND BENEFIT SOLUTIONS EMPLOYEE'S STATEMENT      To file a statement as a public employee enrolled in a plan administered by Southland Benefit Solutions in connection with injury or accide ...

2284. Form PEEHIP Change Health Insurance and Optional Status Change - Alabama

  INSTRUCTIONS: ALABAMA PEEHIP HEALTH INSURANCE AND OPTIONAL STATUS CHANGE      Alabama public employees enrolled in the state-administered health insurance plan use the document discussed in this article to make an optio ...

2285. Form PEEHIP Enroll Health Insurance and Optional Enrollment Application - Alabama

  INSTRUCTIONS: ALABAMA PEEHIP HEALTH INSURANCE AND OPTIONAL ENROLLMENT APPLICATION     Alabama public employees can use the form discussed in this article to apply for PEEHIP health insurance and optional enrollment. This doc ...

2286. Form JRF MMCR - Salary Monthly Member Contribution Remittance Probate Judges on Salary - Alabama

INSTRUCTIONS: ALABAMA MONTHLY MEMBER CONTRIBUTION REMITTANCE PROBATE JUDGES ON SALARY (Form JRF MMCR - Salary)     Alabama probate judges who are members of the Judicial Retirement Fund and compensated by salary are required to contrib ...

2287. Form JRF MMCR - FEE Monthly Member Contribution Remittance Probate Judges on Fee - Alabama

  INSTRUCTIONS: ALABAMA MONTHLY MEMBER CONTRIBUTION REMITTANCE PROBATE JUDGES ON FEE (Form JRF MMCR - FEE)     Alabama probate judges compensated by fees who are members of the Judicial Retirement Fund must annually contribute ...

2288. Form JRF SS Application of Surviving Spouse for Retirement Benefits - Alabama

  INSTRUCTIONS: ALABAMA APPLICATION OF SURVIVING SPOUSE FOR RETIREMENT BENEFITS (Form JRF SS)     In Alabama, surviving spouses of employees enrolled in the Judicial Retirement Fund of Alabama file a form JRF SS to request the ...

2289. Form JRF 12 Insurance Authorization Form - Alabama

2290. Form JRF 1-C Enrollment Blank - Alabama

  INSTRUCTIONS: ALABAMA ANNUAL INVESTMENT OPTION ELECTION DROP ROLLOVER OR 457 TRANSFER (Form RSA-1 IOE)     Alabama public employees enrolled in the state-administered RSA-1 delayed compensation retirement fund can use a form ...