Oxford Forms
We’ve put together some frequently used forms to help when you need them.
Medical Forms
- Oxford Voluntary Direct Debit
- Additional medical forms can be found by logging in to www.oxfordhealth.com and accessing the forms link found on the Tools and Resources Tab
Pharmacy
Stand Alone Vision Benefit
Members with UnitedHealthcare Vision® coverage who are also covered by an ACEC Trust medical plan can use their medical ID number to access vision benefits. Members with stand-alone UnitedHealthcare Vision coverage can use their Social Security number to access vision benefits.
- Benefit Summary
- Out of Network Claim Form
- Additional benefit details available at www.myuhcvision.com
Stand Alone Dental
- Consumer MaxMultiplier
- Prenatal Dental
- Oral Cancer Screening
- Additional information can be found at www.myuhcdental.com
Life and Disability
Forms
• Life Claim
• Short Term Disability
• Long Term Disability
Sample Certificates
• Short Term
• Long Term
• Group Life
Additional information can be found at www.myuhcspecialtybenefits.com
ACEC, your gateway to the ACEC Life/Health Trust.
Additional Resources:
www.acec.org
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