Benefits Forms
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.
These
documents may be presented in PDF format, which requires the Adobe®
Reader.
Life Insurance and Long Term Disability
Medical History
Statement
Beneficiary Designations
Group Life Conversion Packet Request
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 Plans
Retirement Choice Election
Form
Retirement Choice
Release
Form
Social Security Release
Form
Great-West Enrollment Form
Great-West
Beneficiary
Great-West
Distribution Form
Hartford Enrollment Form
Hartford
Distribution Form
ICMA Enrollment Form
ICMA
Distribution Form
PERA 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
|
Division of Human Resources