Health Care & Benefits Division
Benefit Enrollment
All employee elections are completed online.
Active Duty Military Leave Forms
Domestic Partnership/Common Law Marriage Forms
Legislator Forms
Reduction in Force (RIF) Forms
- RIF Prepayment Option Form (Agency Use Only)
Pre-Retirement Forms
Retiree Form
Retiree Payment Options Forms
Surviving Dependent Forms
Benefit Administration
Authorization Forms
Flexible Spending Accounts (FSAs) Forms
Life Insurance Forms
- Conversion Application
- Evidence of Insurability
- Portability Application
- Portability & Conversion Comparison
Pharmacy Forms
-
Costco Prescription Drug Mail Order Form (Membership not required)
- Navitus Direct Member Reimbursement Claim Form
- Ridgeway Prescription Drug Mail Order Form
Other Benefit Forms
Sick Leave Fund and Direct Grant Forms
- Direct Grant Procedure & Form
- Sick Leave Fund Contribution Procedure & Form
- Sick Leave Fund Grant Request Procedure & Form
- Sick Leave Fund Policy
Healthy Weight Incentive Application Forms
More information about the Healthy Weight Incentive
More information about the Healthy Weight Incentive
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