Benefits

• Request for Group Coverage/Enrollment Form (PDF)
• Statement of Change of Active Employment (PDF)
• Special Enrollment Form (PDF)
• Dependent Eligibility Form (PDF)
• Change of Dependent Coverage Form (PDF)
• Change of Address/Salary Form (PDF)
• Request for Name Change Form (PDF)
• Late Entrant/Prior Waiver Form (PDF)
• Request for Waiver of Benefits Form (PDF)
• Return From Leave of Absence/Disability Form (PDF)
• CBEBT HIPAA Form (PDF)
• CBEBT Summary and Full Notices of Privacy Practices (PDF)
• Dependent Handicap Status (PDF)
• Divorce Decree Information (PDF)
• Full Time Student Dependent Eligibility (PDF)
• Medco Rx HIPAA Authorization Form (PDF)
• Other Coverage Update (PDF)

• About Human Resources
• Benefits
• General Information
• CBEBT Forms
• Dental Plan
• Flexible Spending Account
• Life Insurance
• Long-term Disability
• Medical Plan
• Prescription Drug Plan
• Retirement: 403(b) Plan
• Retirement: Defined Benefit Plan
• Vision Plan
• Workers' Compensation
• Employment Opportunities
• Hiring
• Human Resources Forms
• Policies and Procedures