Forms And Resources, On-line, Downloadable | In One Place

Member Forms

Forms & Resources At Your Fingertips

Are you looking for policies?

Welcome to the WEA Trust's online library of Forms & Resources. Here, you'll find a variety of viewable and/or downloadable online forms, links and PDF documents neatly organized for our members, employers and providers.

If you aren't able to locate a specific item, please Contact Us.

Privacy Practices

For information about how your medical information may be used or disclosed and how you can get access to it, please read our Notice of Privacy Practices.

No Surprises Act

For more information about balance billing under the No Surprises Act, please read Your Rights and Protections Against Surprise Medical Bills.

General
HIPAA
Prescription Drugs
Life
State Plan

General Forms

HIPAA Forms

Designation of an insurance representative - Used to grant full access to your Protected Health Information
Authorization of a third party - Used to grant limited access to your Protected Health Information
Authorization to a provider
Participant revocation of authorization
Participant right to access protected health information
Request for alternative communications

Prescription Drug Forms

Prescription Drug Claim Form

Life Forms

State Plan Forms

Grievance Procedure

Customer Service

800-279-4000

Call us Monday through Friday - 7:30 a.m. to 5:00 p.m. CST

Email Us Today

For WEA Member Benefits (auto and home insurance & retirement services), call 800-279-4010

Customer Service