| Medical Benefits |
| Medical Care Enrollment Form (new hires) |
| Medical Care Enrollment Form (qualifying life events) |
Medical Claim Form - Coventry Health Care
|
| Medical Claim Form - BlueCross BlueShield |
| International Claim Form - BlueCross BlueShield |
| Coverage Request for Mentally Retarded or Physically Handicapped Children - BlueCross BlueShield |
| Handicapped Dependent Application and Certification - WellPath |
| Dental Benefits |
| Dental Care Enrollment Form (new hires) |
| Dental Care Enrollment Form (qualifying life events) |
Dental Claim Form - Ameritas
|
| Vision Benefits |
| Vision Care Enrollment Form (new hires) |
| Vision Care Enrollment Form (qualifying life events) |
| Vision Plan Claim Form (for out-of-network providers) |
| Pharmacy Benefits |
| Medco Claim Form |
| Medco Mail Order Form |
| Mental Health and Substance Abuse Benefits |
| CIGNA Out-of-Network Claim Form |
| Disability |
| Hartford Personal Health Statement |
| Voluntary Disability Enrollment Form |
| Hartford Voluntary LTD Conversion Form |
| Educational Benefits |
| Employee Tuition Assistance Program Application |
| Children's Tuition Grant Program Application |
| Health and Wellness Forms |
| Placement Health Review |
| Health Review for Animal Handlers |
| Tuberculosis Questionnaire |
| Tuberculosis Screening Documentation |
| Travel Questionnaire |
| Flu Vaccine Reporting, Exemption, or Declination |
| Life Insurance |
| Basic Life Insurance Beneficiary Designation Form |
| Personal Accident Insurance Enrollment/Beneficiary Form |
| Supplemental Life Insurance Enrollment Form |
| Reimbursement Accounts |
| Reimbursement Accounts Enrollment/Change Form |
| Health Care Reimbursement Account Claim Form |
| Dependent Care Reimbursement Account Claim Form |
| Retirement |
| Retirement Plan Contribution Form |
| Request for Benefits Estimate - Employees' Retirement Plan |
| Fidelity Enrollment Application |
| TIAA-CREF Enrollment Application |
| VALIC Retirement Enrollment Application |
| Vanguard Enrollment Application |
| Same Sex Spousal Equivalency |
| Declaration of Same-Sex Spousal Equivalent Relationship |
| Same-Sex Spousal Equivalent Certification of Dependent Status |
| Affidavit Terminating a Same-Sex Spousal Equivalent Relationship |
| Work Absences |
| Leave of Absence Request Form (Form 1001) |
| Payroll Leave of Absence Form |
| Certification of Health Care Provider for Employee's Serious Health Condition (Form 1002) |
| Certification of Health Care Provider for Family Member's Serious Health Condition (Form 1002) |
| Certification for Serious Injury or Illness of Covered Servicemember |
| Certification of Qualifying Exigency for Military Family Leave |
| Designation Notice (Family and Medical Leave Act) (Form 95) |
| Notice of Eligibility and Rights & Responsibilities (Family and Medical Leave Act) (Form 1003) |
| Kiel Program Application Form |
| Kiel Program Donor Form |
| Kiel Payment Form |
| Paid Parental Leave Request: Primary Caregiver Affidavit |
