Forms
- Health Net Enrollment Application
- Payroll Deduction Authorization Form
- Hardship Extension Form
- American Rescue Plan Act 2021 Application (Blue Form)
- Ineligibility of American Rescue Plan 2021 Application (Yellow Form)
- Life Insurance Beneficiary Designation Form
- Liberty Dental Enrollment Form
- Employee Disability Credit Form
- Kaiser Enrollment Form
- Express Scripts Home Delivery Form
- Express Scripts Claim Form
- Delta Dental Enrollment Form
- MLK Enrollment Form 2024 (English)
- COBRA Election Form
- COVID-At Home Claim Form
To Save the document on your computer, right click, then select Save Target As (or Save Link As).
Disclaimer: Health benefits are available only if your employer participates in the Health Benefit Fund by paying the proper contributions. If you are in doubt as to whether contributions are being made on your behalf, check with your employer or the Administrative Office.