Downloadable Form

When mailing these completed forms back to us, please send them to:

Health Benefit Services
1205 Windham Parkway
Romeoville, IL 60446-1679

The forms can also be faxed to us at 630-378-3005.

Click here for Downloadable Forms.

Forms include:
Changes/Updates
Dependent Forms
Enrollments
Enrollments & Dependent Forms
Leave of Absences
Miscellaneous
Privacy
Reimbursement Forms
Terminations & Leave of Absences
Terminations/Waivers

Only members of the following trust(s) may view the full details of this program:

Christian Brothers Employee Benefit Trust
Christian Brothers Religious Medical Trust

If you are a member of one of these trusts, please login or register for more information.