Benefits Forms

Information about Benefits Forms and Supporting Documentation

Medical, Dental, and Flexible Spending Account Forms

Medical Enrollment and Change Form:

 

Flexible Spending Account (FSA) Enrollment Forms:

 

Health Plan Eligibility & Deduction Authorization for Both Spouse Employees Form:

 

Disability Certification for Over-age Dependent Forms:

 

Disability and Leaves Forms

Family Medical Leave (FMLA) Forms:

 

Leave of Absence (LOA) Form:

 

Life Insurance Forms

FCERS Life Insurance: Securian Financial for members of FCERS

VRS Life Insurance: Securian Financial for members of VRS

 

Retirement and Supplemental Retirement Savings Plans Forms

457(b)

Hybrid 457