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: MetLife for members of FCERS

    Most actions, including beneficiary designations, can be completed through your MetLife account. Go to MetLife's website at Under employer name, search for “Fairfax County Public Schools”. (First-time users will need to click “Register” to create their account.) 

    Please note: Cancellations of coverage cannot be done through MetLife’s website and must be done by phone or in writing.  

    • By phone: Contact MetLIfe at 1-866-492-6983.  Hours are Monday – Friday, from 8 a.m. to 11 p.m. ET.
    • In writing (be sure to include your name and other identifying information):  MetLife, PO Box 14401, Lexington, KY 40512-4401

    VRS Life Insurance: Securian Financial for members of VRS


    Retirement and Supplemental Retirement Savings Plans Forms


    Hybrid 457