Health Care & Benefits Division

HCBD Forms

Forms requiring a digital signature will need to be downloaded to your computer and opened in Adobe Acrobat or Adobe Reader for the signature field(s) to work properly.

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 Termination Form

Retiree Payment Options Forms

Surviving Dependent Forms

Surviving Dependent Election Form

Authorization Form

Authorization for Release of Protected Health Information

Flexible Spending Accounts (FSAs) Forms

Life Insurance Forms

Pharmacy Form

Navitus Direct Member Reimbursement Claim Form

Sick Leave Fund and Direct Grant Forms

Healthy Weight Incentive Application Forms
More information about the Healthy Weight Incentive