• Please Note: The files listed below are in PDF format. Reading PDF forms requires Acrobat Reader. To download Acrobat Reader, click on the image below.

 

 

Health Insurance

• Benefit Comparison 2008

• Benefit Summaries 2008

• Certificate of Dependent Status Eligibility Form

• COBRA Rights Information

• Dental Plan Description

• Dental Provider Directory

• Employee Benefits Policy & Procedures Manual

• Kaiser Physician Selection Form

• Out of Area Waiver Form

• PacifiCare Prescription Mail Order Form

• Universal Enrollment/Change Form

• Vision Plan Description

• Waiver Form

Life Insurance and Long Term Disability

• Reliastar Life Insurance Enrollment/Change Form

• Reliastar Life Insurance Evidence of Insurability

• Reliastar Life Insurance Policy

• Reliastar Management Long Term Disability Policy

Flexible Spending Accounts

• Flexible Spending Account Claim Form

• Flexible Spending Account Information Packet

• FSA Direct Deposit Enrollment Form

Deferred Compensation- Hartford

• Hartford 457 Loan Packet

• Hartford Address Change Form

• Hartford Beneficiary Designation Form

• Hartford Contribution Change Form

• Hartford Direct Deposit Authorization Form

• Hartford Hardship Withdrawal Request Application

• Hartford Pre-Retirement Catch-Up Form

• Hartford Rollover Plan to Plan Transfer Form

• Hartford Rollover Provider to Provider Transfer Form

• Hartford Systematic Payment Change

• Hartford Systematic Payment Enrollment

• Hartford Withdrawal Request Form

• Hartford Withholding Authorization Form

Deferred Compensation- Diversified

• Diversified Direct Rollover Form

• Diversified Distribution Form

• Diversified Enrollment/Change Form

• Diversified Hardship Withdrawal Request Application

• Diversified to Hartford Provider to Provider Transfer Form

• Diversified Pre-retirement Catch-up Provision Form

• Diversified Survivor Benefit Request Form

PARS- Public Agency Retirement System

• PARS Designation of Beneficiary Form

• PARS General Information Sheet

• PARS Plan Summary

• PARS Government Pension Offset Info

• PARS SSA-1945 Cover Letter

• PARS SSA-1945 Notification

• PARS Windfall Eliminate Provision Info

e-Benefits

• e-Benefits Information

Please Note: The files listed below are in Power Point format. If you are unable to view the file, click here to download Power Point Viewer.

• e-Benefits Self-Service Tutorial

 

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