These forms are in either a .doc or a .pdf file format. To read and print the .pdf you may need to download the latest version of Adobe® Acrobat® Reader (free) from the Adobe site.

All forms must be printed, completed and signed before submission to the Payroll & Benefits Department. Electronic submission of forms is not permitted at this time.

New Hires Enrollments/Qualifying Events

State Health

Dental/Vision Claims

AFLAC – Accident, Critical Illness and Hospital Indemnity

Benefits Termination

  • Notice for employees on the benefits they may continue.

Group Life

Disability Insurance

Genomic Life

To continue coverage when terminating, call 800-521-3535

Long Term Care Insurance