Equitable Plan Services, Inc.

Third Party Administrators

 

 

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Member Forms

To view and print a blank form, click your mouse on the desired form below.  The forms require Adobe Acrobat Reader in order to view.  The software is FREE from Adobe. After Adobe has been installed the forms are simple to view, print and manage.  For further assistance please email billingelib@epstpa.com.

Employee / Dependent Terminations and Other Changes

Click Here

Employer / Group Changes

Click Here

Claims Request

Click Here

Enrollment Form for Self Funded

Click Here

 
Download times will vary depending on your Internet connection and the activity of the information server.  You will also want to use the best quality available with your current printer.  Laser printers are recommended when printing forms.

 

 

 



If you're looking for a company specializing in claims management, health benefits and administration to help lead your business into the next century, turn to the one that shaped the last decade --
Equitable Plan Services.