Forms

All forms must be printed, completed and signed before submission to the Human Resources Department or to the carrier. 

ENROLLMENT/CHANGE FORMS

Benefit Election / Change Form (Medical/Dental/Dependent Life)

Vision Enrollment/Change Form (Qualifying Events and New Hires)

Retiree Benefits Change Form

Part Time Dental Enrollment/Change

MEDICAL- PCP CHANGES

BlueCross BlueShield HMO PCP Designation

Kaiser HMO PCP Designation

FLEXIBLE SPENDING

MedCom Form Repository – Pick the one you need!

Flexible Spending Account Enrollment Form

Flexible Spending Account Claim Form

Daycare Provider Receipt

Recurring Transaction Reimbursement Request

Direct Deposit Setup Form

Spouse Card Request

VISION

Out of Network Claim Form

GROUP LIFE AND DISABILITY

Port Request and Instructions – One America

Life Claim Packet and Day by Day Guide – OneAmerica

Evidence of Insurability – Employee and Spouse –  OneAmerica

Beneficiary Designation/Change Form – OneAmerica 

AFLAC

Instructions for Online Filing and Direct Deposit

AFLAC Cancer Wellness Form

AFLAC Accident Wellness Form

AFLAC Hospital Indemnity Wellness Form

AFLAC Claim Forms

AFLAC Waiver of Premium when disabled

AFLAC Cancellation Form

AFLAC Change: Transfer to Payroll/Direct Billing/Address

UNUM INDIVIDUAL LIFE

E-Sign Forms Online Library

Life Service Form – English (Unum)
pages 1-2 are instructions, so do not print or return to Unum.

Life Service Form – Spanish (Unum)

UNUM Life Application