Bookmark & ShareEmployee Medical/Dental
2010 Employee Enrollment Guide (1.3 MB)- 2010 Employee Enrollment/Change (353.4 KB)
- 2010 Employee Enrollment/Change Medical Only Groups (451.3 KB)
Life Insurance
- 2010 Life Insurance Booklet (366 KB)
- 2010 Life Insurance Change Form (140.7 KB)
- 2010 Life Insurance Enrollment Form (101.3 KB)
- 2010 Life Insurance Evidence of Insurability (80.5 KB)
- 2010 Portability Choice Form (509 KB)
Instructions for filling out the Life Insurance Enrollment form- Instructions for filling out the Life Insurance Change form
- Life Claim Information Sheet (for use by employer groups only) (198.4 KB)
- Non-Smoker Certification (Amendment to Original Application)
- Change in Beneficiary
- Death Claim
- Waiver of Premiums
- Accelerated Benefit Claims
- Life Conversion Information Request
Long-Term Disability
- 2010 Long-Term Disability Booklet (184 KB)
- 2010 Long-Term Disability Enrollment/Change (45 KB)
- Instructions for filling out the Long-Term Disability Enrollment form
- Instructions for making changes to your Long-Term Disability
- 2010 Long-Term Disability Evidence of Insurability (42.1 KB)
- Long-Term Disability Employee’s Statement (199 KB)
- Long-Term Disability Employer’s Statement (136.5 KB)
- Long-Term Disability Notification Form (202.5 KB)
- LTD Claim Information Sheet (for use by employer groups only) (115.8 KB)
Dependent Certifications
- 2010 Adult Dependent Enrollment/Change (366.6 KB)
- 2010 Dependent with Disabilities (326.6 KB)
- 2010 Extended (Legal) Dependents (385.6 KB)
- 2010 Determining Dependent Tax Status (292.8 KB)
Miscellaneous
- Section 125 Brochure (27.3 KB)
- Section 125 Waiver form (142.5 KB)
- Authorization for Release of Information (146 KB)
- Electronic Debit Service Agreement (352.7 KB)
- Payment Discrepancy Reporting form (92.4 KB)
- Insurance Eligibility System Adjustment form (185.6 KB)
- Termination and LWOP Insurance Checklist (69.3 KB)
- Employer Decision Notice (232.2 KB)
