INFORMATION FOR RETIRED STATE EMPLOYEES
This page contains information for retired State of Wyoming employees. There are downloadable files and links to external websites. Be sure you have the latest version of Adobe Reader to access PDF files. If you have questions or require assistance, contact a benefits specialist at (307) 777-6835 or email@example.com.
MASA Ambulance Election Form (only available for non-Medicare eligible retirees, IF ambulance was elected prior to retiring.)
Direct Pay Authorization Authorization form to deduct premiums from a bank account
MedImpact Direct Rx Mail Order Form To claim reimbursement when a prescription has not gone through a retail pharmacy
MedImpact Claim Form Used for manual submission of prescription reimbursement
Cigna Medical Claim Form Used to send medical claims to Cigna