Forms

Open Enrollment Forms 

• Evidence of Insurability Form
• HSA Enrollment Form

Benefits

• Employee Insurance and Benefits Change Form 
• Dependent Add Form 
• LTD Claim Form
• Medical Claim Form
• Travel Reimbursement Form (must be submitted with a fully completed medical claim form)

Health Savings Account (HSA)

• HSA Enrollment Form
• HSA Change Form

Life Insurance

• Beneficiary Designation Form
• Evidence of Insurability Form

Retiree Forms

• Enrollment Benefit and Change Form
• Automatic Bank Draft Application

Deferred Compensation

• 457 Enrollment Form
• Roth IRA Enrollment Form
• FIN2 – Payroll Adjustment Authorization

Fitness Center

• Fitness Center Liability Waiver