Forms Online provides IASIS Healthcare employees with instant access to the most recent version of frequently used forms. Use Forms Online to eliminate phone calls, delivery time, and photocopy time and expense. Forms Online is your first stop for self service electronic forms. Select the form you need and print a copy—it’s that easy.

General Employment:

• W-4 (Updated Annually)
  Use this form to withhold the correct federal income tax from your pay.
   
• SS-5
  Use this form to apply for a new or a replacement Social Security Card.
    
• AZ A-4 Form
  Use this form to calculate and elect to withhold a percentage of one's pay for Arizona state tax.
   
• L-4 Form
  State of Louisiana state income tax form.
   
• Direct Deposit Form
  Use this form to have your pay deposited directly to your checking or savings account.

Health and Welfare Plan Forms:

• Medical
  
  • BCBS - PPO Medical Claim Form
    Use this form to file out-of-network medical claims.
     
• Pharmacy
  • Caremark - Mail order Rx Form
    Use this form to submit maintenance mail order prescription drugs for 90-day supply to Caremark.  
  • Caremark Drug Reimbursement Form
    Use this claim form when you have paid full price for a prescription drug order at a pharmacy.
  • Caremark Prescription Drug Handbook
    This sample handbook includes information about your prescription drug benefit for retail and mail-order services.
  • Caremark FAQ
    Review this forms for frequently asked questions.
  • Caremark Participating Retail Pharmacies
    Review this form to obtain list of retail participating pharmacies in the network. Please visit Caremark website for  most up-to-date listing.
     
• Dental
  • Metlife Dental Claim Form
    Use this form to file an out-of-network dental claim.
     
• Vision
  • Vision Claim Form
    Use this form to file an out-of-network vision claim.
     
• Flexible Spending Accounts
  • WageWorks Healthcare Reimbursement Form
    Use this form to request reimbursement for eligible healthcare expenses not paid by insurance.
  • WageWorks Dependent Care Reimbursement Form
    Use this form to request reimbursement for eligible dependent care expenses not paid by insurance.
     
• Wells Fargo - 401(k) Forms
  • 401(k) Beneficiary Form 
    Use this form to designate beneficiary(ies) for plan. Please submit completed form to your Human Resources Department.
  • 401(k) Distribution Form
    Use this form to request the total distribution of the balance of your 401k Plan account.
  • 401(k) Rollover Contribution Form
    Use this form to roll money from another eligible account to the Wells Fargo account.
     
• Life and Accidental Death and Dismemberment (AD&D)
  • Beneficiary Form
    Use this form to designate who will receive the Basic and Voluntary Group Life Insurance proceeds in the event of your death.
  • Notice of Group Life Conversion
    Your employer must complete form and submit to employee to convert their life insurance policy. This notice must accompany the Employee’s Kit for Group Life Conversion application.
  • Employee's Kit for Group Life Conversion
    Use this kit to convert employee and/or dependent Basic or Supplemental Group Life to an individual life policy with Sun Life Financial. You must have a completed Notice of Group Life Conversion Form from your employer to send with application.
  • Life Claim Packet 
    Use this packet to file a claim for Life, Accidental Death & Dismemberment (AD&D), Waiver of premiums, and accelerated benefit claims.
  • Death Benefits Claim Packet
    Use this form to file a claim in the event of the death of an insured employee or dependent.
  • Evidence of Insurability 
    Use this form to provide evidence of insurability for Sun Life Supplemental employee and dependent life and Long-Term Disability (LTD)
  • Evidence of Insurability (Florida Only)
    Use this form to provide evidence of insurability for Sun Life Supplemental employee and dependent life and Long-Term Disability (LTD)
     
• Disability
  • Evidence of Insurability 
    Use this form to provide evidence of insurability for Sun Life Supplemental employee and dependent life and Long-Term Disability (LTD)
  • Short Term Disability Claim Packet
    Use this packet and form to apply for Short-Term Disability (STD) benefits. The form must be completed by Human Resources, the employee, and the employee’s healthcare provider to assist in the determination of STD benefits.
  • Long Term Disability Claim Packet
    Use this packet and form to apply for Long-Term Disability (LTD) benefits. The form must be completed by Human Resources, the employee, and the employee’s healthcare provider to assist in the determination of LTD benefits. 
  • Reliance Voluntary Short Term Disability Claim Form
    Use this form to file a claim for the Voluntary employee paid Short Term Disability.
  • Reliance Voluntary Short Term Disability Highlights
    Review this form for information on disability income protection.