Forms

NEW for 2019! Beneficiary Designation form

Cigna [accident, supplemental life insurance, long term disability]

• Accidental Injury: How to Submit a Claim
• Accidental Injury Claim Form
• Benficiary Designation Form
• Long Term Disability Packet (to be updated in March 2019)

Dependent Affidavits [for dependents on your plan]

• Affidavit of Marriage
• Domestic Partner Packet

Health Savings Account [for High Deductible Plan]

• Salary Reduction Agreement

Health and Wellness

• Credit or Case Management Non Utilization of Service Fee Accommodation Application
• Waiver/Accommodation Form

Retirement Plan [for voluntary contributions]

• Salary Reduction Agreement
• Salary Reduction Catch Up

Spouse Surcharge [if employed spouse on your plan]

• Spouse Surcharge Agreement