COPS Benefit Information

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COPS Member Forms & Resources

Understanding your benefits and managing a claim shouldn’t add stress to your life. You should always have the guidance you need to know how to get the most out of your benefits, and we’re here to do just that. Get the forms and resources you need to quickly and simply manage your healthcare.

Appeal Request Form

If you need to appeal a denied benefits request, use this form to start the process.

Enrollment Application

Use this form to enroll in a benefits package.

FSA Enrollment Application

Need to enroll in a Flexible Spending Account? Use this form to do so

FSA Reimbursement Form

If you have a Flexible Spending Account, use this form to submit your expenses to be reimbursed.

FSA Dependent Care Reimbursement Form

If you have a Flexible Spending Account, use this form to submit your dependent care expenses to be reimbursed.

HRA Reimbursement Form

Complete this form to receive funds from your Healthcare Reimbursement Agreement account to cover healthcare costs

PHI Release / Designation of Person Form

Complete the form to allow your provider or other party to release your health information.

Status Change Form

If you’ve had a life change event, use this form to update your status, add or remove dependents, and more.

Student Verification Form

If one of your dependents is a student over the age of 18, use this form to verify their dependent eligibility.

Contact Us

We’re here to answer your questions or get your the information you need. Contact us using the number found on the back of your ID card.