Forms


Benefits Enrollment/Change Form (Medical, Dental, Vision)
Benefits Enrollment/Change Form
Flexible Spending Account (FSA) Election Forms
2020 FSA Election Form
2020 FSA Status Change Form (Qualifying Events Only)
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
Employee's Designation of Beneficiary Under Government Code 53245
Employee's Designation of Beneficiary Under Government Code 53245

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