Employee Benefits

Health & Dental Coverage Forms

• BCBS Lifestyle Benefits Claim Form
• BCBS Subscriber Claim Form
• Benefits Selection Form 2012
• Dental Claim Form
• Dental Low Option - 2011
• Dental High Option - 2011
• Domestic Partnership Affidavit
• Generic Drug Trial Program
• Health Plan Comparison 2012
• Health Plan Comparison 2011
• HIPAA Authorization Form
• Lifestyle Benefit Reimbursement Form
• Waiver of Group Health Insurance
• Waiver of Group Dental Coverage

Flexible Spending Account Forms

• EBS FSA changes 2011
• FSA Claim Form
• FSA Enrollment Form
• FSA Enrollment Kit

Family & Medical Leave Act (FMLA) Forms

• Medical Certification: Family Member - Employee
• Request for Family or Medical Leave

Disability & Workers' Compensation Forms

• DB-450 Claim Form
• Disability Statement of Rights
• Incident Report
• Workers' Compensation Claimant Information Packet
• Workers Compensation Pharmacy Form

Other Benefits Information

• Leave Request Form
• Vacation Carry Over Request Form
• Sick Bank Criteria Form
• Sick Bank Donation Form
• Sick Bank Request Form
• Family Financial Planning Information
• Tuition Remission: Dependent - Employee
• Emergency Sick Time Bank Policy
• Tuition Exchange Policy
• Business Council Summary Annual Report

Retirement Planning

• Summary Plan Description for TIAA-CREF RA
• Summary Plan Description for TIAA-CREF TDA
• Agreement for Salary Reduction