Forms and Documents

ODA Wellness Trust Forms and Documents

This page contains forms and documents that may be useful to you as you enroll in a plan with the ODA Wellness Trust.

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Forms should be completed, printed and faxed to the ODA Wellness Trust at 614-340-9444.

An email is generated to confirm receipt of all faxes submitted to ODAWT at (614) 340-9444 within one business day.  Please include with your fax an email address where the fax receipt confirmation should be sent.   If you do not receive a confirmation of fax receipt (please check your junk/spam file), the ODAWT has not received your fax.

Extreme caution should be used when sending personal health information via regular email.


We can answer any questions you may have about your health benefits. Contact us today, we're here to help!