Forms

NEW! Benefits Authorization form

Aetna [long term disability, supplemental life insurance]

note: provider will change to Cigna on 1/1/19

• Life Insurance Beneficiary
• Long Term Disability Packet

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