If you have trouble accessing the documents on this page, please email us at benefits@missoulacounty.us. We're happy to help you.

   Office Forms for Benefits

•   Yearly Update Request Fillable Form (.pdf)
•   Accident/Injury Information Request Fillable Form (.pdf) 
•   Flex Medical Expense Reimbursement Request Fillable Form (pdf)
•   Flex Dependent Expense Reimbursement Request Fillable Form (.pdf)
•  Flex Direct Deposit Fillable Form (.pdf)
•   Ridgeway Mail Order Pharmacy
•   Costco Mail Order Pharmacy
•   Claim Submittal Form 
•   R-2 Release of Confidential Information Fillable Form (.pdf)
•  Prior Auth Form

Office Forms for Risk

Accident Injury Reporting Policy
Notice of Loss or Claim
Auto Accident Report (.pdf)

Office Forms for Work Comp

Reporting Instructions for Employers
Notice of Injury for (Missoula County Employees) 2021 Fillable Form (.pdf)
Notice of Injury for (Outside Agencies) 2021 Fillable Form (.pdf)

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