Forms

Medical Forms

Claim Form – Prescription – CVS Caremark

Claim Form – FSA – Navia (APEA Employees)

Change of Address Form

Enrollment Form (APEA Employees)

Enrollment Form (JESS Employees)

Medical/Dental Claim Form

Vision – VSP – Reimbursement Form

Privacy and Disclosures

Authorization for Disclosure of Protected Health Information

Health Trust – Notice of Privacy Practices

Revocation of Protected Health Information Disclosure

Mail All Completed Claim Forms

APEA-AFT Trust
PO Box 34840
Seattle, WA 98124-1840