Enrollment
New Employee or Eligible for a change in benefits? Enroll now!
Forms
Vision
Cigna/NY Life [accident, hospital care, Life, AD&D, Short and Long Term Disability]
- Beneficiary Designation Form
- Cigna Accidental Injury - How to Submit a Wellness Claim
- Cigna Accidental Injury - Wellness Claim Form
- Cigna Accidental Injury and Hospital Care - How to Submit a Claim
- Cigna Accidental Injury Claim Form
- NY Life Basic and Supplemental Life and Accidental Death & Dismemberment (AD &D) Claim Form
- NY Life Short Term Disability Claim Form
- NY Life Long Term Disability Claim Form
- NY Life Disability Claim Physician's Statement
Dependent Affidavits [for dependents on your plan]
- Affidavit of Marriage
- Affidavit of Domestic Partnership
- Termination of Domestic Partnership
- Domestic Partner (DP) Benefits and Imputed Income
Health Savings Account [for High Deductible Plan]
HIPAA Release
- IBX Authorization for Disclosure of Health Information
- Health Advocate Authorization form
- Cigna Disclosure Authorization Form