Forms
Available Benefits Forms
Choose a link below to print a benefits form. These forms are 508 compliant and may be filled out online and printed. If you have the Adobe tools you can even save these forms with your information.
Plan Year 2022 (January - December) Forms
2022 Additional Dependents Form
2022 Other Dependent Form
2022 Change Form
2022 Common Law Spousal Form
2022 Health Insurance Portability Accountability Authorization
2022 Newly Eligible
2022 Spousal Exclusion Request Form
2022 Employee Opt Out Acceptance Form
2022 Life Insurance Application
2022 Life Insurance Mid Year Application
2022 Benefits Enrollment Form
2022 Decrease Supplemental Life Insurance
2022 American Fidelity HSA Application
2022 COBRA Qualifying Event Notice
2022 Benefits Coordinator Appointment
2022 HealthChoice Tobacco Attestation
Plan Year (January - December) 2021 Forms
2021 Additional Dependents Form
2021 Other Dependent Form
2021 Change Form
2021 Common Law Spousal Form
2021 Health Insurance Portability Accountability Authorization
2021 Newly Eligible
2021 Spousal Exclusion Request Form
2021 Employee Opt Out Acceptance Form
2021 Life Insurance Application
2021 Life Insurance Mid Year Application
2021 Benefits Enrollment Form
2021 Decrease Supplemental Life Insurance
2021 American Fidelity HSA Application
2021 COBRA Qualifying Event Notice
2021 Benefits Coordinator Appointment
2021 HealthChoice Tobacco Attestation