These forms are in either a .doc or .pdf file format. To read and print the .pdf you may need to download the latest version of Adobe® Acrobat® Reader (free) from the Adobe site.

All forms must be printed, completed and signed before submission to the Human Resources Department. Electronic submission of forms is not permitted at this time.

If you need any additional form contact us at: Coweta@houze.org.

Benefit Enrollment Election Form

Dental & Vision Enrollment/Change Form

Health Plan Enrollment/Change Form or SHBP Paper Enrollment Form

SHBP Dependent Eligibility Form

Group Life Evidence of Insurability Form

Group Life and Waiver of Premium Claim Form

Physicians Statement & Authorization

Group Life Claim Form & Settlement Options

Group Life Conversion Information Request

Cobra Vision Form

Dental Claim Form- Out of Network

Vision Claim Form- Out of Network

Short-term Disability Claim Form -- STD Claim Notice -- STD Doctor Statement

Long-term Disability Claim Form -- LTD Claim Notice

Cancer Insurance Application

Cancer Claim Form - AFLAC

Cancer Claim Form - American Heritage

Shenandoah Individual Life - Lost Policy Form

Shenandoah Individual Life - Change Form

Shenandoah Individual Life - Cash Surrender Form

MedCom Flex Claim Form

MedCom In Home Day Care Receipt

MedCom Flex Spouse Card Request Form

MedCom Flex Direct Deposit Form

MedCom Flex Family Status Change Form

MedCom Flex Enrollment Form

Student Accident Claim Form