General Forms

These are the general forms necessary for HEALTHY LIFE, to enroll, show proof of other insurance, and subrogation agreement.

HEALTHY LIFE Reference Card Bring this reference card to your HEALTHY LIFE doctor’s appointment to make sure your exam covers the requirements.

Fund’s Enrollment Form Complete this form if you are newly eligible or experience a change in family status (e.g., marriage or birth of a child).

Proof of Other Insurance
Complete this form if you or a dependent has insurance coverage through another plan (e.g., your spouse’s employer).

Subrogation Agreement
The Fund has the right to recover payments it makes on your behalf for an illness or injury should you receive money as a recovery from another party for the same illness/injury.