Young Adult Insurance Coverage Affidavit ProAct Mail Order Enrollment Form FSA Plan Enrollment Form Request For Dependent Care Reimbursement Request For Healthcare Reimbursement Direct Reimbursement Vision Claim Health Care Reimbursement Account Claim Extension Form Dependent Care Reimbursement Account Claim Extension Form Domestic Partnership Declaration Statement Prescription Coordination of RX Benefits Claim Termination of Domestic Partnership Vision Care Claim Medical Expense Claim Form **All Portable Document File (PDF) formatted files require the Adobe Acrobat Reader to be installed on your system. If you do not have the Acrobat reader, you can download it for free by clicking on the 'Get Acrobat Reader' graphic below.

Tiered Prescription Drug Formulary January 2012 UNITED HEALTHCARE AND EAST END HEALTH ALLIANCE SIGN AGREEMENT SEPTEMBER 16, 2011 EEHP Annual Report Special Bulletin: Drug Benefit Transitions   Request for automatic deduction of health insurance premium   Use and Disclosure of Protected Health Information   East End Health Plan - News & Notes   Request for auomatic deduction of health insurance premium   Young Adult Insurance Coverage Affidavit   Student Certification Procedure   Prescription COB Claim Form   East End Health Plan Overview of Flexible Benefits Plan and Procedures for Plan Participants   East End Health Plan Medical Expense Claim Form   East End Health Plan Benefit Summary

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