Below are your forms for download. You may download each form individually, or the Form Package, which contains all of the forms. You will need the free Adobe Acrobat Reader to open the Benefit Plan forms. Click here to get Acrobat Reader.

Please note that the forms can be large in size and may require extended download times at slower connection speeds.

Please note that you may only use the forms on this page
if you live in Hawaii (HI).

• Form Package (1.1 MB)
• Individual Forms
  • Enrollment
    • Enrollment Form
    • Enrollment Instructions
    • Bank Draft Authorization
  • Group Life Insurance Plan
  • Short-Term Disability Income Plan
  • Dental Insurance Plan
  • Group Critical Illness Plan
    • Critical Illness Plan Application
  • Group Supplemental Hospital Indemnity Basic Plan
  • Group Supplemental Hospital Indemnity Premier Plan
  • Mid Med Medical Plan - Level One
  • Mid Med Medical Plan - Level Two
  • Group Accident Insurance Plan
  • Prescription Drug Plan
  • EyeMed Vision Care Plan
  • Short-Term Major Medical Plan

*Important Disclosure - Please Read!*

The current MidMed Level 1 and MidMed Level 2 plan group contract will be discontinued effective February 28, 2011. If you should choose to enroll in either MidMed Plan now, please be aware you will have this coverage for a limited amount of time. For additional information regarding this important change, please contact a customer service representative at 1-800-644-6854.

Area 2-HI