Medical Benefits

Medical Benefits for You and Your Family More

Health and Wellness

Resources for Living Well with AMOP More

Retirement Services

Plan for Your Future More

Vacation Benefits

Apply Now More

Safety & Education

STAR Center- Dania Beach Campus More

Medical Clinic Services

On Site USCG Physicals & Wellness Resources More

Medical Plan Forms


Coordination of Benefits (COB):

Application for Benefits:

Scholarship Applications:

Protected Health Information (PHI) Authorization Forms:

Disability Applications:

Medical Plan Beneficiary Designation:




Please note: If you do not see the form you are looking for, please contact the Plan office at (800) 348-6515 Ext. 12 or by e-mail.

Downloading Forms: You can download, view, and print forms from this website. The forms on our website are in fillable format for your convenience. In order to enter your information on the form you may have to complete the following steps:

  • All of our forms are in PDF format.
  • You need Adobe Reader to view and print forms.
  • View a form by double-clicking it or use the following steps to download the form:
    1. Right-click on the form link or "View form" icon.
    2. Select "Save Target As" or "Save Link As".
    3. Save the form on your computer. Make a note of where you save the form.
    4. Open Adobe Reader.
    5. Select File, select Open, locate the form, and double-click on the form name.

If you are having problems: If you are having problems downloading forms, completing fill-in forms, or printing fill-in forms, please visit this link