Forms & Downloads
- Mid-America Home Covid Testing Member Reimbursement Form
- Mid-America Surprise Billing Notice
- Prior Authorization Referral Form
- Precertification Requirements
- Liberty Union Life Insurance Certificate
- Disabled Dependent APS Form
- Michigan Diabetes Statement
- Women's Cancer Annual Notice
- Personal Identification Form
- Eligibility Questionnaire Form
- Change of Address Form
- Liberty Union Employee Application
- Dental Enrollment Form
- Caremark Mail Order Form
- Caremark Reimbursement Form
- Liberty Union Privacy Statement
- Liberty Union Group Change Form
- Healthy Choice Plan Participation Overview and Required Forms
- Healthy Choice Testing Compliance 1500 Deductible Plan
- Healthy Choice Testing Compliance 2500 Deductible Plan
- Healthy Choice Testing Compliance 5000 Deductible Plan
- Liberty Union Privacy Statement
- APPEAL DENTAL Authorization to Release PHI Form
- Designated Representative Fully Form
- Self-Funded Authorization to Release PHI Form
- Liberty Union Authorization To Release Confidential Medical Information