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 Overage Dependent Forms:


Disability and Leaves Forms

Family Medical Leave (FMLA) Forms:


Leave of Absence (LOA) Forms:


Life Insurance Forms

FCERS Life Insurance: MetLife for members of FCERS

VRS Life Insurance: Securian Financial for members of VRS


Retirement and Supplemental Retirement Savings Plans Forms