Handy Forms

The following forms are available for downloading and printing.
The forms are in "pdf" format and require Acrobat Reader to open.
If you do not have Acrobat Reader, you can go to Adobe's web site and download it using the link below.

HPI Enrollment Form

HPI Flex Claim Form

HPI Flex Over the Counter Claim Form

Standard Medical Claim Form

Standard Dental Claim Form

Short Term Disability Form

Supplemental Claim Form

DirigoChoice Enrollment Change Form

Employer Password Authorization Form

For groups where the group number starts with 001N, use the following flex claim form
HPI Flex Claim Form-001N

DME Request Form
Outpatient Therapy Service Request Form

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