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Forms
Affidavits
Beneficiary Change forms
- Basic and Optional Life Insurance Online Beneficiary Designation
- County Death Benefit Beneficiary Designation (administered by Human Resources Department)
- County Accidental Death Insurance (administered by Human Resources Department)
- ICMA Employee Information Change form
- NACo Participation Agreement
- FRS Pension Plan Beneficiary Designation form for active members
- FRS Investment Plan Beneficiary Designation form for active members
Claim forms
- AvMed MDC/JHS Claim Reimbursement form
- Delta Dental Claim form
- MetLife Dental Expense Claim form
- Vision Care Benefits Claim form
Deferred Compensation
Election/Enrollment Forms
- AvMed Away from Home Program
- Transition of Service form
- Benefits Election form - Health & Flex
- Group/Optional Life Enrollment/Beneficiary Designation
- Health Plans Change in Status form
- Flex Benefits Change in Status form
Flexible Spending Account
Long/Short Term Disability Claim forms
- MetLife Statement of Health form - STD/LTD
- STD Disability Claim form
- LTD Claim form - Employee Statement
- LTD Claim form - Employer Statement
- LTD Claim form - Attending Physician Statement
Workers Compensation forms
- Minor Injury Log
- Supervisor Investigation Report
- Employee Supplemental Report of Injury
- Wage statement
- Workers comp chart
- Injured Worker Prescription Form
- Workers comp booklet
Other
- MetLife Statement of Health Form - Life Insurance
- Death Benefit Payment Form
(County Resolution 81-02 Death Benefit)
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Page Last Edited: Tue Nov 29, 2011 8:57:53 AM
files, you can download Acrobat Reader for free from Adobe Systems, Inc. In order to use PDF files, you must have Acrobat installed on your computer.benefits
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