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 firstname.lastname@example.org.
- Retiree Insurance Application
- Direct Pay Authorization Authorization form to deduct premiums from a bank account
- Medicare Part D Certificate
- 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