Law Enforcement Health Benefits Inc.
2233 Spring Garden Street 19130 | Philadelphia Pennsylvania | 215-763-8290
John J. Gaittens, Administrator
Below is a list of LEHB's most commonly requested forms. You may print out a blank form from it's link on this page, or you may request a blank form be emailed to you. Or you may request that a form pre-filled out form be mailed to your address of record on file with LEHB. Please make your selection below and click the "submit" button.
Click on the links below and download the form
Coordination of Benefits form
Add or remove a dependent form
Change of address form
Authorization to Release Information
Vision Claim Form