Forms

Forms

Benefit change form—complete for a qualified life event/family status change

Medical and Prescription Drug

Aetna medical claim form
Aetna new prescription mail order form
Aetna prescription drug reimbursement form 
HMSA coordination of benefits form (Hawaii employees only)

Dental

Delta Dental claim form

Health Savings Account

HSA contribution change form
HSA rollover or transfer request form 
HSA withdrawal/distribution request form
HSA designation of beneficiary form

Flexible Spending Accounts

FSA claim form
FSA change form

Beneficiary Designations

Life insurance beneficiary designation form
401(k) beneficiary designation form

Other Forms

Commuter benefit enrollment form
Filing short term disability claims
Filing Workers Compensation claims
Life insurance evidence of insurability form and instructions
Unum voluntary critical illness application to request a change in coverage