Benefit Forms

  • To make changes to your current coverage (or elect coverage) outside of Open Enrollment, you must have a HIPAA qualifying event, for additional information, please refer to the Benefits Booklet or Medical Guide.

    Enrollments/changes must be completed within 31 days of event (new hire (start date), FTE changes, child/spouse dependent eligibility such as marriage, birth, or adoption). Forms can be submitted directly through the submission portal or by downloading the document, completing it, and uploading to the Benefits Dropbox. Please contact Benefits if you have any questions. 


  • New Hires or New Enrollment

  • Adding / Terming Dependent (Open Enrollment or Qualifying Event)

  • Part Time Benefit Eligible Employees, Waiving/Declining coverage ONLY (if you will be enrolling dental, vision, and/or medical please refer to New Hire or New Benefit Eligible Employees section above)

All Forms