Insurance Forms

Health Insurance
Basic Health Coverage Application (pdf) Dependent Change Form (pdf) Foster Child Certification (pdf)
Dental Insurance
Basic Health Coverage Application (pdf) Dependent Change Form (pdf) Foster Child Certification (pdf)
Disability Insurance
Claim Process Overview (pdf) Disability Claim Application - Long-Term (pdf) Disability Claim Application - Short-Term (pdf) LTD/STD Claim Application (pdf) Manager's Income Protection Plan Application (pdf) Optional Application (Life Insurance, AD&D, Disability) (pdf)
Life Insurance
Life Insurance-Request to Waive or Apply (pdf) Optional Application (Life Insurance, AD&D, Disability) (pdf)
Long Term Care Insurance
Change Form (pdf) Short Form Application (pdf) Complete if you are an employee who is enrolling late or a spouse of an employee Long Form Application (pdf) Complete if you have retired, you are the spouse of a retired employee or the partents of an employee
Pre-Tax
EideBailly Reimbursement Form-Plan Yr 2013 Pre-Tax Benefits Forms & Applications (EideBailly Site) Pre-Tax Request to Waive Mid-Year (pdf)
Changing Coverage Outside of Open Enrollment
Dependent Change Form (pdf) Basic Health Coverage Application (pdf) Optional Application (Life Insurance, AD&D, Disability) (pdf) Eide Bailly (EideBailly Site) Foster Child Certification (pdf) Pre-Tax Request to Waive Mid-Year (pdf) Qualified Life Event Summary (pdf)