Employee

• Employee Enrollment/Change (722.9 KB)
• Employee Enrollment/Change for Medical Only Groups (350.8 KB)
• Life Insurance Change Form (182.8 KB)
• Life Insurance Enrollment Form (141.9 KB)
• Life Insurance Evidence of Insurability Form (430 KB)
• Long Term Disability Enrollment/Change Form (127.2 KB)
• Long Term Disability Evidence of Insurability (277.6 KB)
• Non-Smoker Certification (144.5 KB)
• Section 125 Waiver Form (122.4 KB)

Retiree

• Medicare Advantage Disenrollment (Form D) (569.4 KB)
• Medicare Advantage Enrollment (Form C) (724 KB)
• Medicare Supplement Enrollment (Form B) (539.1 KB)
• Retiree Coverage Election Form (Form A) (770.8 KB)

Continuation of Coverage

• COBRA Continuation of Coverage (270.4 KB)
• Leave Without Pay (637.6 KB)
• Life Insurance Conversion (280.1 KB)
• UMP Conversion (241.2 KB)

Dependent Certification

• Dependents with Disabilities (314.1 KB)
• Extended (Legal) Dependents (336.5 KB)
• Spouse or Qualified Domestic Partner Certification (706.2 KB)
• Student Certification/Change (59.5 KB)

Miscellaneous

• Authorization for Release of Information (121 KB)
• Change in Beneficiary (62.3 KB)
• Electronic Debit Service (124.5 KB)