Forms

Revised HSD Employee Benefits Guide

HSD Benefits Enrollment Form

Benefits Summaries

Kaiser HMO

Delta Dental

United Concordia Dental

MES Vision

Lincoln Financial Voluntary Life

Lincoln Financial Short-Term Disability

Lincoln Financial Long-Term Disability

Blue Cross Select HMO 

Blue Cross Vivity HMO

Blue Cross HMO Prescription Plan

Blue Cross PPO

Blue Cross PPO Prescription Plan

Summary of Benefits and Coverages (in accordance with the Affordable Care Act)

Kaiser HMO

Blue Cross PPO

Blue Cross Select HMO

Blue Cross Vivity HMO

Forms
Kaiser Application

Delta Dental Application

United Concordia Dental Application

MES Vision Application

Lincoln Financial Application

Blue Cross Application

Blue Cross Change Form

Flexible Benefits Plan Salary Redirection Agreement

Health Care FSA Claim Form

Dependent Care FSA Claim Form