The following  forms are available in Adobe Acrobat PDF format.  To get Adobe Acrobat, click here            

Healthplex Participating Dentists -- New York

Healthplex Participating Dentists -- New Jersey and Pennsylvania

Healthplex Plan Description and Fee Schedule

Healthplex Enrollment Form

MEDCO Mail Order Form

MEDCO Direct Reimbursement Form

Express Scripts Mail Service Form for GHI-covered medications

Participating Optical Center - Metro New York

Participating Optical Centers - Outside Metro New York

Student Verification Form