FORMS

Health Plan Forms:

• Benefits Election Form (.pdf)
  
  
• CIGNA enrollment/change Form (.pdf)
  
  
• CIGNA Medical Claim Form (.pdf)
  
  
• CIGNA Prescription Drug Claim Form (.pdf)
  
  
• Online Health Screening Form

Dental Plan Forms:

• Dental Election Enrollment Form (.pdf)
  
  
• Dental Claim Form (.pdf)

Vision Plan Forms:

• VSP Enrollment Form (.pdf)
  
  
• VSP Vision Plan Change Form (.pdf)

Flex Spending Account Forms:

• Flexible Spending Account Enrollment Form (.pdf)
  
  
• Flexible Spending Claims Form (.pdf)
  
  
• Additional Flex Card Request Form (.pdf)

Supplemental Life, Accidental Death and Dismemberment (AD&D) Plan Forms:

• Life Beneficiary Change Form (.pdf)
  
  
• Life Enrollment Form (.pdf)
  
  
• Short Term Disability (STD) Application Form (.pdf)
  
  
• Short Term Disability (STD) Enrollment Form (.pdf)
  
  
• Evidence of Insurability Form (.pdf)
  

401k & Retirement Forms :

• 401k Beneficiary Change Form (.pdf)
  
  
• 457 Change Form (.pdf)
  
  
• Retiree Benefits Election Form (.pdf)
  
  
• Retirement System Beneficary Change Form (.pdf)

Forms require the free Acrobat Reader.