Forms
415
page-template,page-template-full_width,page-template-full_width-php,page,page-id-415,page-child,parent-pageid-826,bridge-core-1.0.7,ajax_fade,page_not_loaded,,qode_grid_1300,footer_responsive_adv,hide_top_bar_on_mobile_header,qode-theme-ver-18.2.1,qode-theme-bridge,disabled_footer_top,qode_header_in_grid,wpb-js-composer js-comp-ver-6.7.0,vc_responsive
 

Forms

Member Forms

Click to download III-A Forms:

III-A Employee Enrollment Form

III-A Claims Form

III-A Employee Change Form

BCI Member Claim Form

Coordination of Benefits Form

Disabled Member Form

When submitting a form to the III-A that has personal information, please request a secure email from III-A staff or fax to 208-575-6423

Member Benefit Information

III-A Member Benefit Videos 2020-21:

Standard Plans

First Responder Plans

Facebook