Forms


Medical Enrollment/Change Form
Universal VEBA Enrollment/Change Form (Kaiser Permanente/UnitedHealthcare)
Dental & Vision Enrollment/Change Form
Dental & Vision Enrollment/Change Form
Flexible Spending Account (FSA) Election Forms
2019 – FSA Election Form
2018 – FSA Election Form
Cancellation Notice for Self-Pay Health and Life Insurance
Cancellation Notice for Self-Pay Health and Life Insurance
Debit Authorization for Benefit Premiums
Debit Authorization for Benefit Premiums
Payroll Deduction Cancellation Form – Voluntary Insurance
Payroll Deduction Cancellation Form -  Voluntary Insurance
Declaration of Domestic Partnership
Declaration of Domestic Partnership

CARRIER AGREEMENTS:
Kaiser Permanente
UnitedHealthcare
Dental Plans (Delta Dental and Western Dental)
Flexible Spending Accounts (FSA)