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)
Applications and Forms
Retiree Applications
Wellmark State of Iowa Retiree Application
Iowa Group MedicareBlue Rx Application (for Group Program F or N)
Iowa Group MedicareBlue Rx Application (for Iowa Choice/National Choice)
Electronic Funds Transfer (EFT) Forms
Wellmark Automatic Payment Authorization
Group MedicareBlue Rx Automatic Payment Authorization
Delta Dental Automatic Payment Authorization
Contact Information
- Department of Administrative Services, Human Resources Enterprise - 866-895-2464 or stateretirees@iowa.gov
- Wellmark, Blue Cross Blue Shield of Iowa – Customer Service - 800-622-0043
- MedicareBlue Rx – Customer Service - 877-838-3827
- Medicare website - www.medicare.gov/
- Senior Health Insurance Information Program (SHIIP) - 800-351-4664 or shiip.iowa.gov/