Flexible Spending Account Forms

• Flexible Spending - Claim Form.pdf
• Flexible Spending - Letter of Medical Need.pdf
• MRA Options at Employment End.pdf
• Tax Favored Accounts - Enrollment and Change.pdf

Health Benefit Forms

• BCBS Non-Network Claim.pdf
• Health Insurance Election Form.pdf
• Spouse Program - Health Insurance Form.pdf

Life Benefit Forms

• Beneficiary Designation.pdf
• Evidence of Insurability.pdf
• Group Life Conversion Form.pdf
• Group Life Portability Form.pdf
• Life Enrollment.pdf

Special Forms

• Application for Educational Leave with Pay.pdf
• FICA-Alternative-Plan-Distribution-Form.pdf
• FMLA Employee Medical Leave.pdf
• FMLA Family Leave.pdf
• Leave Request Form.pdf
• Pre Tax Waiver Form.pdf
• Request for Overtime.pdf
• Spouse Program Election and Change.pdf
• Tax Exemption Application for Tuition Fee Waiver.pdf

Sick Leave Pool Forms

• Sick Leave Pool Application.pdf
• Sick Leave Pool Credit.pdf
• Sick Leave Pool Donation.pdf

Retirement Forms

• AFLAC FRS Insurance Payroll Authorization.pdf
• AFLAC Retiree Request for Change.pdf
• Cancellation Form for Miscellaneous Deductions and Insurances.pdf
• FRS Authorization Gabor Retiree.pdf
• FRS Certification Form.pdf
• New Retiree Enrollment and Change.pdf
• ORP 16A Contributions Change.pdf
• Philadelphia American-Retiree Conversion.pdf
• Retiree Benefits Package.pdf
• Retiree Enrollment and Change.pdf
• Tax Deferred Annuity Payroll Authorization.pdf

Supplemental Forms

• Accident Election Form.pdf
• AFLAC Wellness Benefit.pdf
• Alta Hospital Supplemental Claim.pdf
• Authorization to Disclose PHI Form.pdf
• Cancer Election Form.pdf
• Dental Enrollment and Change.pdf
• Disability Election Form.pdf
• Gabor Disability Enrollment.pdf
• Hospitalization Election Form.pdf
• Intensive Care Election Form.pdf
• Philadelphia American Claim.pdf
• Vision Election Form.pdf