Form Library

Everything you need in one place.

Below you’ll find links to information and forms, which you can view or download and print.

If you prefer talking with a HealthEZ representative, call 1-888-806-3142

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2025 Medical Benefit Information
 
Benefit Overview Provides a high level overview of your medical benefits.
Copay Plan 1 SBC Provides an easy-to-understand summary about a health plan’s benefits and coverage.
Copay Plan 2 SBC Provides an easy-to-understand summary about a health plan’s benefits and coverage.
HSA Plan SBC Provides an easy-to-understand summary about a health plan’s benefits and coverage.
2025 Summary Plan Description (SPD) Provides information on how the medical plan operates, when employees are eligible for benefits, how benefits are paid, and much more.
HealthEZ Resources
 
Understanding Your ID Card Provides an easy-to-understand summary about how to read your HealthEZ ID card.
Boost Your Baby HealthEZ offers maternity support by providing education and resources to promote a healthy pregnancy through postpartum
HealthEZ EZPay Manage all your medical expenses in one simple spot with EZpay. Everything you need is at your fingertips in the free HealthEZ app.
How to find your HealthEZ EOB's & Statements How to find your HealthEZ EOB's & Statements
EZFit
 
EZFit Overview and Reimbursement Form EZFit from HealthEZ makes it easy for you to get credit for health club workouts.
Claim Reimbursement Forms
 
Medical Expense Reimbursement Form Fill out the Medical Expense Reimbursement Form and submit to HealthEZ when you have paid out of pocket for medical expenses.
Prescription Reimbursement Form Fill out the Prescription Reimbursement Form and submit to your Pharmacy Benefit Manager (PBM) when you have paid out of pocket for prescription expenses.
Ancillary Benefits
 
Ancillary Plan Benefit Overview Provides a high level overview of the ancillary plan.
Regence BCBS FocalPoint SBC The Summary of Benefits and Coverage provides simple and consistent information about covered benefits, coverage limitations, cost sharing provisions, and exceptions.
Regence BCBS ValueCare SBC The Summary of Benefits and Coverage provides simple and consistent information about covered benefits, coverage limitations, cost sharing provisions, and exceptions.
Machine Readable File
 
Machine Readable File – Cigna Network Machine Readable Files, published in accordance with the Transparency in Coverage final rule. The information contained in the files is accurate as of the “Last Updated” date and is subject to change at any time and without notice.
PLEASE NOTE: Due to the amount of information contained in these files, some may be as large as one Terabyte (TB) in size. Please ensure you have the required memory capacity, hardware, and software capabilities before attempting to download. The Machine Readable Files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
Machine Readable File - Out of Network Machine Readable Files, published in accordance with the Transparency in Coverage final rule. The information contained in the files is accurate as of the “Last Updated” date and is subject to change at any time and without notice.
PLEASE NOTE: Due to the amount of information contained in these files, some may be as large as one Terabyte (TB) in size. Please ensure you have the required memory capacity, hardware, and software capabilities before attempting to download. The Machine Readable Files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.
HealthEZ Resources
 
HealthEZ Resources Provides instructions on downloading the MyHealthEZ app and creating an online account.
Member Portal Overview A brief video overview of your MyHealthEZ portal where you be able to find EOBs, statements, accumulator data, ID cards, and so much more.
Boost Your Baby HealthEZ offers maternity support by providing education and resources to promote a healthy pregnancy through postpartum.
HealthEZ EZPay Manage all your medical expenses in one simple spot with EZpay. Everything you need is at your fingertips in the free HealthEZ app.
Understanding Your ID Card Provides an easy-to-understand summary about how to read your HealthEZ ID card.
Claim Reimbursement Form
 
Medical Expense Reimbursement Form Fill out the Medical Expense Reimbursement Form and submit to HealthEZ when you have paid out of pocket for medical expenses.
Pharmacy Reimbursement Form Fill out the Prescription Reimbursement Form and submit to your Pharmacy Benefit Manager (PBM) when you have paid out of pocket for prescription expenses