Appeal Form:
Complete this form if you are pregnant/postpartum or have a chronic illness to be exempt from a Biometric Screening.
Submit this form by using the link below or faxing 402-939-0604.
Non-Baird Dental or Vision Preventive Exam Form:
Earn credit for completing a Non-Baird Dental or Vision Preventive Exam with your Provider between 9/21/24-9/19/25.
Forms will be processed, and credit given in 10-14 business days.
