Forms

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 Claim Forms

• Medical Mutual of Ohio Medical Claim Form-Claims must be submitted to Medical Mutual, P.O. Box 6018, Cleveland, OH 44101-1018.
• Medical Mutual of Ohio Dental Claim Form-Claims must be submitted to Medical Mutual, P.O. Box 6018, Cleveland, OH 44101-1018.
• Caremark Order Form for Prescription Drugs

• CoreFlex/CoreSource Flex Spending Claim Form-Return to Address on Form
• Annualized Dependent Care Reimbursement Form

Additional Insurance Forms

• Sun Life Beneficiary Designation Form - Can be completed with a family status change or at any time.  Return to the Personnel Department
• Authorization for Release of Protected Health Information - Return to Personnel Department with any supporting documentation, if any.

General Forms

• Application for Leave
• Employee Change of Information Form
• State of Ohio Tax Form
• Federal Tax Form (W-4)
• Emergency Notification Form
• Direct Deposit Form

Employees can click here to access additional forms.

Note: This link only works from within the City of Bowling Green network.