Healthy Mouth = Healthy You

Medical

Expatriate Prescription Drug Authorization Form (Express Scripts)

Key Health Insurance Words (video)

Medical Claim Form POS II (Including instructions)

Medicare Supplement Plan Claim Form

Ordering medications from Express Scripts by mail (mail order pharmacy)

Prescriptions Claim Form (Express Scripts)

Pre-Tax Spending Plan (Flexible Spending Account)

Employee Dependent Care Affidavit - Flexible Spending Account Dependent Care Reimbursement Account

Employee Health Care Affidavit - Flexible Spending Account Health Care Reimbursement Account

Pre-Tax Direct Deposit Form

Dependent Care Flexible Spending Account Claim Form

Health Care Flexible Spending Account Claim Form

Pre-Tax Claim Instructions

Click here to find the following IRS Publications located on the irs.gov website.

IRS Publication 502 - Medical and Dental Expenses

IRS Publication 503 - Child and Dependent Care Expenses

IRS Publication 2441 - Instructions for Child and Dependent Care Expenses

IRS Form 2441 - Child and Dependent Care Expenses

Vision

ExxonMobil Vision Plan

U.S. Expats & Rotators mail order anti-malarials

Anti-Malarial Mail Order Program Notice

ExxonMobil Expat Skill Center Letter to Employees Explaining the Program

ExxonMobil Malaria Chemoprophylaxis Prescription Fax Order Form

  • Word document (you can edit, save and attach to an e-mail)
  • PDF document (you can print, write on changes, bring or mail to prescriber - changes cannot be saved)

Medical information and disclosure

Aetna

Cigna

Express Scripts

Spectera Vision

Magellan Healthcare