REMEMBER: Enrollment can only be completed through online enrollment. These forms pertain to very specific instances in which a form must be filled out separately from the online benefits administration system. See the Related Links below for more information about online enrollment.

Life Insurance

Evidence of Insurability Form for Life Insurance - also called Medical History Statement; from Minnesota Life

Long Term Disability (LTD)

Medical History Statement for LTD - Standard Insurance

Affidavits
Custody of Grandchildren
Custody of Foster Children
Common Law Marriage
Dependent Children
Affidavit of Marriage

Claim Forms
Delta Dental Claim Forms
FSA Claim Form

Standard Disability

Retirement
PERA Choice & Forms

Flexible Spending Accounts
Direct Deposit / E-mail Notification Authorization Form  takes you to ASIflex site

Related Links
Rates
Who is my human resources contact?
Insurance Companies' Phone Numbers
What do "Pre-tax" and "After tax" mean?
Instructions for Online Enrollment
Enroll / Change Benefits
HealthLine
Glossary of Insurance Terms
Forms
Salary Reduction Plan
 

For Employee Benefits contacts: DPA Benefits Unit.

Email comments to:  DPA Benefits