Enrollment Forms

• FCPS - Employee Medical Plan Enrollment & Change
• FCPS - Dental Enrollment & Change for Employees and Retirees
• Flexible Spending Account (FSA) Enrollment
• FSA Direct Deposit Authorization
• Documentation for Midyear Benefit Changes
• FSA Change in Status
• FCPS - Spouse Health Plan Deduction
• Instructions for Completing the CNA Long-Term Care (LTC) Enrollment Form
  • CNA Enrollment Form - for employees who enroll during their first 30 days after being hired
  • CNA Short Form - for spouses who enroll at anytime, and employees enrolling outside of their 30 day initial enrollment period
• Application Instructions for CNA LTC Long Form
  • CNA Long Form - for parents and grandparents and in-laws of employees who wish to enroll