Medical and Prescription

(These documents are in a PDF format)

• 2009 Medical & Dental Enrollment/Change Form
• 2008 Medical & Dental Enrollment/Change Form
• Uniform Medical Claim Form
• Uniform Medical Prescription Claim Form

Dental

• Uniform Dental Claim Form

Insurance Eligibility (PDF Format)

• Dependent Student Certification Form

Life Insurance (PDF Format)

• Life Insurance Enrollment/Change
• Life Insurance Evidence of Insurability
• Life Insurance Change of Beneficiary
• Life Insurance Conversion Form
  (to continue optional life insurance at termination or retirement)
• Non Smoker Certification

LTD Insurance (PDF Format)

• Long Term Disability Enrollment/Change
• Long Term Disability Evidence of Insurability

Name and Address (MS Word Format)

• Name / Address Change Form

Retirement and Savings

• PERS/LEOFF/TRS Enrollment and Member Information Form (PDF Format)
• PERS/TRS/LEOFF Beneficiary Designation (PDF Format)
• Supplemental Retirement Plan Enrollment/Change Form (MS Word Format)

Flexible Spending Account (PDF Format)

• FSA Enrollment/Claim Form

COBRA and Self-Pay (PDF Format)

• COBRA Information and Enrollment
• Self-pay Information and Enrollment