Forms Made Easy

Lang Insurance Service is always available Monday - Friday from 8:00 am to 5:00 pm to assist you. Please call us at 636-229-7000 to let us know how we can help. For your convenience, many of the forms you may need to add an employee, change contact information, etc. are provided below. Please contact us with any questions!

Form
Description
Form Type
Anthem Find a Provider
Instructions on how to find a provider.
Anthem Preventative Care
Information about preventative care guidelines and services.
Change Existing Policy
Request a change to an existing policy.
Coventry Find a Provider
Instructions on how to find a provider.
Coventry Preventative Care
Information about preventative care guidelines and services.
Dental Insurance Quote
Request a quote for Dental Insurance.
Individual Health Quote
Request a quote for Individual Health Insurance.
Life Insurance Quote
Request a quote for Life Insurance.
Long Term Care Quote
Request a quote for Long Term Care insurance.
Medicare Supplement Quote
Request a quote for Medicare Supplement insurance.
United Health Care Find a Provider
Instructions on how to find a provider.
United Health Care Preventative Care
Information about preventative care guidelines and services.
Update contact information
Update your contact information.
Lang Insurance
Description
Form Type
How to Appoint Lang Insurance as Your Agent
How to appoint Lang Insurance as your agent when applying online
How to Locate Group Health Forms
How to locate group health forms on the Lang Insurance website
Group Census Form
Provide employee information for a Group Health quote.
Downloadable Group Census Form
Provide employee information for a Group Health quote.
ANTHEM
Anthem Enrollment Form
New hires, Open enrollment, Waiver, Qualifying event, COBRA
Anthem Change Form
Address change, Life benefit, Life Class, Cancel/waive coverage, Benefit Change, Cancer Dependent, Name Change, Other
Anthem Life with Medical
Applying for life when coming on late (did not apply when first hired)
Anthem Life Only Application
Use for new hire
Anthem ACA Employee Application
(Groups who moved to an ACA plan
2014 and after)
Anthem ACA enrollment for - New hires, Open Enrollment Qualifying Event, COBRA, other
Anthem ACA Employee Change Form
(Groups who moved to an ACA plan
2014 and after)
New hires, Open enrollment, Qualifying event, COBRA, other
Anthem Dental Employee Enrollment Form
New hires, Open enrollment, Qualifying event, COBRA, other
Anthem Termination Form
Use only is leaving company
Anthem Medical Claim Form
File a medical claim
Anthem Prescription Reimbursement Form
Use for requesting reimbursement for a prescription
Anthem International Medical Claim Form
File an international medical claim
Anthem Find a Provider
Instruction on how to find a provider
Anthem Preventative Benefits Care
Information about preventative care guidelines and services
Anthem My Anthem
Access your health plan services online
Anthem Quick Care Options
Guide to the best setting for non-emergency care and avoid unnecessary ER costs
Anthem Procedure Cost Flyer
Know what a procedure costs before getting care
Anthem Explanation of Benefits Reference Guide
Get the most from your benefits by keeping you informed about your claims
Anthem National Drug List 2015
Prescription formulary drug list
Anthem Preventive Care Smoking Cessation
Quit Smoking with support from Anthem
Anthem Blue View Vision Better Health for Eyes
Better health is right before your eyes
Anthem Pediatric Dental Benefit Summary
Pediatric Dental Benefits at a glance
Anthem Pediatric Dental EHB Flyer
Dental Pediatric Essential Health Benefits
Anthem Pediatric Vision Flyer
Vision Pediatric Essential Health Benefits
UNITED HEALTHCARE
UnitedHealthcare Enrollment/Change Form
New Hire, open enrollment, waiver, qualifying event, COBRA, addition, address change
UnitedHealthcare Prescription
Reimbursement Form
Use for requesting reimbursement for a prescription
UnitedHealthcare Find a Provider
Instruction on how to find a provider
UnitedHealthcare Preventative Benefits Care
Information about preventative care guidelines and services
UnitedHealthcare Health4me Mobile App
Your family's health care resources, in your hands
UnitedHealthcare Accessing Your
Health Benefit Plan
Benefit Plan quick reference guide
UnitedHealthcare – myuhc.com
Myuhc.com Step-By-Step Registration Process
UnitedHealthcare New Member Brochure
A handbook about your UnitedHealthcare member tools
United Healthcare Where Do I Go For Care
Helping you choose the right care center
UnitedHealthcare Urgent Care ER
Guide to the best setting for non-emergency care and avoid unnecessary ER costs
UnitedHealthcare Pediatric Dental Brochure
Guide to Pediatric Dental Essential Health benefit
UnitedHealthcare Pediatric Vision Brochure
Guide to Pediatric Vision Essential Health benefit
UHC 2015 Drug List
Prescription Formulary list
UHC ACA Generic Prescriptions
Program for members that maintains affordable acces to medications
UHC Pharmacy Benefits Program
Reducing costs and supporting better health
UHC Ancillary Charge Program
Guiding members to lower-cost generic medication options while ensuring choice and access
UHC Member Select Experience Map
Flexibility to fill maintenance medications through OptumRX mail service pharmacy
UHC Optum RX Mail Order Form
New prescription Mail-In order form
UHC Advantage PDL
$0 Cost Share Contraceptive Medications & Products
UHC Mail Service Pharmacy
Member Announcement
Delivery program that will allow you to receive your currnt medication by mail
UHC Mail Service Member Select
The ideal blend of cost-saving performance and flexibility Optum Rx Mail Service Pharmacy
Using Your Vision Insurance at a Network Provider Location
The information required for the provider to verify your vision eligibility
How to Print Your Vision ID Card
How to Print your Vision ID Card
COVENTRY (GHP)
Coventry/Aetna Enrollment/Change Form
New Hire, open enrollment, waiver, qualifying event, COBRA, addition, address change, termination
Coventry/Aetna Dental Enrollment/Change Form
New Hire, open enrollment, qualifying event, COBRA, addition, address change, termination
Coventry/Aetna Vision Enrollment/Change Form
New Hire, open enrollment, qualifying event, COBRA, addition, address change, termination
Coventry/Aetna Life Enrollment/Change Form
New Hire, Rehire, Change, Termination
Coventry/Aetna Disability Enrollment/Change Form
New Hire, Rehire, Change, Termination
Coventry/Aetna Life/Disability Enrollment/Change Form
New Hire, Rehire, Change, Termination
Coventry/Aetna Prescription Reimbursement
Use for requesting reimbursement for a prescription
Coventry/Aetna Find a Provider
Instruction on how to find a provider
Coventry/Aetna Preventative Care
Information about preventative care guidelines and services
Coventry/Aetna My Online Services
Access to your personal information, eligibility and benefits
Coventry/Aetna Wellbeing
Wellness program
Coventry/Aetna Knowing Where to Go
Guide to the best setting for non-emergency care and avoid unnecessary ER costs
Coventry/Aetna EyeMed Vision Care
Savings on vision care
ADVANTICA
New hire, Open enrollment, etc.
Advantica Dental Enrollment/Change Form
New Hire, open enrollment, waiver, qualifying event, COBRA, addition, address change, termination
Advantica Vision Enrollment/Change Form
New Hire, open enrollment, waiver, qualifying event, COBRA, addition, address change, termination
Advantica Flyer
Website address (Find a Provider, View Claim Summary, Request ID Card, and View or Print Benefits)
HUMANA
Humana Employee Enrollment Form Dental/Vision
New Hire, open enrollment, qualifying event, COBRA, addition, address change
Humana Employee Enrollment Form Life AD&D
New Hire, open enrollment, qualifying event, COBRA, addition, address change
Humana Dental.com Flyer
Manage your plan at MyHumana
Humana Dental Claim Receipt
Explanation of how your plan benefits were applied
Humana Dental Healthy Eating
Basics of Healthy mouth
Humana Vision Care
Importance of periodic eye exams
Humana Vision Care Plan
Lasik Procedures/Reduced Fees
Humana Basic Life
Summary of Benefits
Humana Voluntary Life
Summary of Benefits
LINCOLN FINANCIAL
Lincoln Life Employee Enrollment form Life AD&D/ Short Term and Long Term Disability
New Hire, Rehire, Change, Termination
Lincoln Life Beneficiary Designation Form
Primary, Contingent Beneficiary election/change form
Form
Description
Form Type
Auto Accident Report Form
Keep this form in your glove compartment to use in case of an accident.
Auto Insurance Quote
Request a quote for Auto Insurance.
Boat Insurance Quote
Request a quote for Boat Insurance.
Camper/RV Insurance Quote
Request a quote for Camper/RV Insurance.
Change Existing Policy
Request a change to an existing policy.
Classic Car Insurance Quote
Request a quote for Classic Car Insurance.
Condo Insurance Quote
Request a quote for Condo Insurance.
Dwelling Fire Quote
Request a quote for Dwelling Fire Insurance.
Flood Insurance Quote
Request a quote for Flood Insurance.
Home Insurance Quote
Request a quote for Home Insurance.
Home Inventory
Use this form to make an inventory of items in your home
Life Insurance Needs Calculator
Helps to determine amount of Life Insurance needed.
Motorcycle Insurance Quote
Request a quote for Motorcycle Insurance.
Order Auto ID Cards
Request additional Auto policy ID cards.
Renters Insurance Quote
Request a quote for Renters Insurance.
Umbrella Insurance Quote
Request a quote for Umbrella Insurance.
Update Contact Information
Update your contact information.
Form
Description
Form Type
Business Insurance Quote
Request a quote for Business Insurance.
Change Existing Policy
Request a change to an existing policy.
Request a Certificate of Insurance
Request a certificate of insurance.
Update Contact Information
Update your contact information.