Retiree Health and/or Dental Insurance Applications
Application for the Retired/Disabled Health and Dental Insurance Group
Cancellation of Retiree Health and/or Dental Insurance
Sick Leave Insurance Program (SLIP)
SLIP Enrollment
SLIP Calculation Estimate
SLIP Retiree Rehire Authorization
Wellmark Applications
Wellmark State of Iowa Retiree Application
Wellmark Automatic Payment Authorization
Group MedicareBlue Rx Applications
Iowa Group MedicareBlue Rx Application (for Group Program F or N)
Iowa Group MedicareBlue Rx Application (for Iowa Choice or National Choice)
Iowa Group MedicareBlue Rx Disenrollment Form
MedicareBlue Rx Electronic Funds Transfer (EFT) form
Dental Insurance Application
Delta Dental Insurance Application
Delta Dental's Authorization for Automatic Bank Account Withdrawal
updated 02/04/2022