Enrollment/Change Forms

• Benefit Election / Change Form (Medical/Dental/Dependent Life)
• Vision Enrollment/Change Form (Qualifying Events and New Hires)
• Legal Plan Enrollment/Change Form (Qualifying Events and New Hires)
• Supplemental Benefits INTEREST Form for New Hires

• Retiree Benefits Change Form
• Part Time Dental Enrollment/Change

Medical – PCP Changes

• BlueCross BlueShield HMO PCP Designation
• Kaiser HMO PCP Designation

Flexible Spending

• MedCom Form Repository – Pick the one you need!
• Flexible Spending Account Enrollment Form
• Flexible Spending Account Claim Form
• Daycare Provider Receipt
• Recurring Transaction Reimbursement Request
• Direct Deposit Setup Form
• Dependent Card Request Form

Vision

• Out of Network Claim Form

Group Life and Disability

• Port Request and Instructions – One America
• Life Claim Packet and Day by Day Guide – OneAmerica
• Online EOI Instructions –  OneAmerica
• Beneficiary Designation/Change Form – OneAmerica
• Long Term Disability Claim Packet – OneAmerica
• How to file a disabilty claim – OneAmerica

Aflac

• Instructions for Online Filing and Direct Deposit
• AFLAC Cancer Wellness Form
• AFLAC Accident Wellness Form
• AFLAC Hospital Indemnity Wellness Form
• AFLAC Claim Forms
• AFLAC Waiver of Premium when disabled
• AFLAC Cancellation Form
• AFLAC Change: Transfer to Payroll/Direct Billing/Address
• Setup Direct Bill through aflac.com policyholder services.
• Payment Authorization Agreement for manual processing

Cancer Guardian

• Continuation Request  – PORT Coverage when leave/retire

Unum Individual Life

• E-Sign Forms Online Library
• Life Service Form – English (Unum)
  Pages 1-2 are instructions, so do not print or return to Unum.
• Life Service Form – Spanish (Unum)
• UNUM Life Application