Forms Library

General Employer and Employee Forms: Employers and Subscriber form to communicate changes in status
Enrollment and Change Form	Dependent Child Form
Documentation of Other Dental Coverage	Notice of Other Dental Insurance
Status Change Form	Verification of Other Dental Insurance

COBRA Forms: Use these Forms to access your COBRA Benefits if ACS is your Employer's COBRA Administrator
COBRA - Notice of Disability	COBRA - Notice of Quailifying Event
COBRA - Notice of 2nd Qualifying Event	COBRA - Notice of Other Coverage

Please download A Guide to ACS Privacy Forms .  The Guide will give you a description of all of the HIPAA Privacy forms listed below.
Subscriber's (Employee's) Auth for Spouse	Request to Access PHI
Member's Authorization Request	Request to Amend Access to PHI
Confidential Communication Request	Accounting of Certain Disclosures Request
Confidential Communication Change	Request to Restrict Uses or Disclosure of PHI

Provider Forms
Provider Services Registration Form: Use this form to register for Provider Webs Services.
IRS Form W-9: If you are requested to send in a IRS Form W-9 or wish to change your current Tax Identification Number (TIN) or Tax Name. Please download the IRS Substitue W-9 Form. IRS Substitute Form W-9