Benefits Summaries and Forms

HSD Employee Benefits Guide

HSD Benefits Enrollment Form 

EASE Online Benefits System Reference Sheet

EASE Online Benefits User Guide 

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

Anthem Blue Cross Select HMO

Anthem Blue Cross Vivity HMO

Anthem Blue Cross HMO Prescription Plan

Anthem Blue Cross PPO

Anthem Blue Cross PPO Prescription Plan

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

Kaiser HMO

Anthem Blue Cross Select HMO

Anthem Blue Cross Vivity HMO

Anthem Blue Cross PPO

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