Retiree Benefits Forms
Information about Benefits Forms and Supporting Documentation
Medical and Dental Forms
Medical Enrollment and Change Form:
Disability Certification for Overage Dependent Forms:
- Aetna (dental coverage)
(Both forms must be completed and submitted to Aetna):
- Cigna Open Access Plus (medical coverage)
(Both forms must be completed and submitted to Cigna):
- Kaiser Permanente (medical coverage)
- Contact Kaiser Member Services at 301-468-6000
Aetna Dental Benefits Request Form:
Retiree Benefits Publications & Resources
Here you will find FCPS benefits-related publications, resource materials, and forms for retirees.
Here you will find information about how to make changes to your benefits due to a major life event.