Forms and Information for TRS-ActiveCare Benefits Administrators
- 2011–2012 Plan Highlights

- Online Supply Form (submit online)
- Claim Form

- Exception Request Form
(submit online) — Information on how to use this form 
- Transitional Benefits Request/Provider Release of Information

- COBRA Transmittal Form

- Application to Split Premium

- 2011–2012 Employee Enrollment Presentation (PowerPoint)
- Continuation Coverage Rights Under COBRA

- General Notice of Special Enrollment Rights and Preexisting Condition Exclusion

- Notice of Privacy Practices

- CHIPRA Notice


