Forms
NOTE: All forms on this page are in PDF format
- Working Families Tax Relief Act (WFTRA)Declaration Form
- Working Familes Tax Relief Act Information (WFTRA)
- Declaration of Adult Dependent Form
- Physician's Statement for Dependent Child Form-Allegiance
- Physician's Statement for Dependent Child Form-Blue Cross
- Physician's Statement for Dependent Child Form-New West
- New Employee Physicial Exam Form
- EyeMed Claim Form
- Delta Dental Claim Form
- CVS Confirmation Mail Service Enrollment Form
- CVS Prescription Reimbursement Claim Form
- CVS Authorization to Use/Disclose Protected Health Information Form
- CVS Designation of Personal Representative Form
- Ridgeway Mail Order Form
- Cobra Enrollment Form
- Out of State Authorization Form
- Standard Travel Benefit Brochure (regular)
- Standard Travel Benefit Brochure (Expatriate-over 90days)
- Standard Travel Benefit (Expatriate-over 90 days)Form
- Standard Travel Benefit (Expatriate-over 90 days)Certificate
- Flexible Spending Account Forms:
- Flex Reduction Agreement Form
- Flex Dependent Care Claim Form
- Flex Medical Care Expense Claim Form
- Flex Insurance Expense Claim Form
- Flex Direct Deposit Form
- Flex Claims Rollover Form(Blue Cross/Blue Shield participants only)
- Flex Change in Status Form
- Flex Debit (Benny) Card Form
Flex Over the Counter Medicines & Products Brochure
