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The forms below are available online for your convenience.
If you are enrolling in the diocesan health insurance plan, please refer
to the instructions for enrollment.
Diocese
of Washington Request for Insurance Coverage [pdf]
> See note below
Diocese
of Washington Miscellaneous Change Request [pdf]
> See
note below
Diocese
of Washington Request for Cancellation of Insurance [pdf]
> See
note below
CareFirst
Health Insurance Enrollment Application Form [pdf]
CareFirst
Health Benefits Claim Form [pdf]
CareFirst
Dental Claim Form [pdf]
>> If
you do not open this document in your browser, but save it and open it
in Acrobat Reader or the full version of Adobe Acrobat, you can
type your information directly into the form.
PLEASE NOTE: If you are
using Acrobat Reader, the data you enter will not be saved when you save
the file, so you will not be able to e-mail the file to the administrator.
Instead, after typing, print out the form and mail or fax it to the administrator.
If you are using the full version of Acrobat, the data should save when
you save the file, so you can e-mail the form to the administrator. If
you have any technical questions, email the webmaster.
Please contact
the Insurance Administrator if you have questions.
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