Please click on the links to view the forms available for download.
Open Enrollment Booklet 2024 (PDF, 5MB)
Open Enrollment Job Aid(PDF, 1MB)
International Medical Claim Form(PDF, 140KB)
Medical Claim Form(PDF, 378KB)
Prescription Mail Form for Home Delivery(PDF, 259KB)
DHMO Benefit Summary(PDF, 179KB)
Choice Benefit Summary(PDF, 1MB)
Copay Benefit Summary(PDF, 1MB)
Dental Member Oral Health for Overall Health(PDF, 266KB)
AFLAC Booklet(PDF, 852KB)
AFLAC Cancellation Form 2023(PDF, 62KB)
AFLAC Continuing Disability Claim Form(PDF, 48KB)
AFLAC Initial Disability Claim Form(PDF, 52KB)
AFLAC Name Change Form(PDF, 334KB)
AFLAC Request for Change(PDF, 131KB)
AFLAC Outline of Coverage(PDF, 449KB)
Employee Web Registration Flyer(PDF, 309KB)
Humana Find a Doctor(PDF, 453KB)
Humana Vision Summary of Benefits(PDF, 5MB)
Out of Network Vision Claim Form(PDF, 562KB)
Certified Domestic Partner Affidavit(PDF, 26KB)
Certified Domestic Partner Termination(PDF, 9KB)
Benefit Strategies Information(PDF, 276KB)
Claim Reimbursement Form(PDF, 149KB)
Direct Deposit Authorization Form(PDF, 80KB)
FSA Status Change Form(PDF, 32KB)
Standard Beneficiary Form(PDF, 145KB)
Beneficiary Designation Form(PDF, 122KB)
POLICY 918815(PDF, 208KB)
LV Portability Application (Cont. Election)(PDF, 300KB)
Evidence of Insurability Employee Brochure(PDF, 176KB)
Benefits Pricing Sheet(PDF, 1MB)
IDShield Benefits Flyer(PDF, 358KB)
Employee Membership Application(PDF, 238KB)
IDShield Fact Sheet(PDF, 673KB)
IDShield Services and Features(PDF, 1MB)
IDShield vs Credit Monitoring vs LifeLock(PDF, 292KB)
LegalShield Term Form(PDF, 813KB)
LegalShield Video(PDF, 43KB)
LegalShield Your Quick Start Guide(PDF, 377KB)
Member Perks(PDF, 1MB)
Employee Assistance Program Brochure(PDF, 208KB)