Benefit Forms

Benefit Forms

 Benefit Forms

Health Plan Information:

Medical Insurance Forms

PDF IconBlue Cross Blue Shield Member Application for Payment Consideration

PDF IconBlue Cross Blue Shield Prescription Drug Reimbursement Claim Form

PDF IconMedco Mail Order Rx Form

PDF IconHDHP - Getting to Know Your High Deductible Health Plan

PDF IconHDHP - Non-Union

PDF Icon2020 Waiver of Coverage Form


Blue Cross Blue Shield Online Visits

Employees and their dependents can utilize Blue Cross Online Health for both minor illnesses and behavior mental healthcare. 

Blue Cross Online Visits

Sign Up Information for Blue Cross Online Visits

 
Healthcare Bluebook - Transparency Tool

PDF IconCost Quality Flyer

PDF IconGo Green Rewards

NAVIA (Health FSA & Dependent Care Accounts)

PDF IconDebit Card Flyer

PDF IconFlexible Spending Account Worksheet

PDF IconFlexible Spending Account Navigating My Benefits

PDF IconFlexible Spending Account Claim Form

Health Equity - Health Savings Account & Limited Purpose FSA

PDF IconHSA - Getting the Most Out of Your Health Savings Account

PDF IconHSA - Changing your HSA Deductions

PDF IconHSA - Winning with an HSA

PDF IconHSA - Frequently Asked Questions

Vision Plan Information

EyeMed Employee Portal

PDF IconBenefit Summary

PDF IconCreating a login online

PDF IconEyeMed FAQs

PDF IconFreedom Pass

PDF IconHearing Discounts

PDF IconText Alerts

PDF IconMembership Perks

PDF IconOut-of-Network Claim Form

Voluntary Benefits:

Nationwide Pet Insurance

Pet Insurance Benefit Video /Enrollment Page

PDF IconMy Pet Protection Plan

PDF IconPlan Summary

Member Portal - You can use this to:

  • File a Claim
  • Update Contact Information
  • Check Claim Status
  • Review Your Policy

Cigna Information/Forms

Cigna Welcome Guide

PDF IconCigna Health Advocacy Services

PDF IconCigna Discounts and Programs - No additional Cost!

Accident Insurance

PDF IconVoluntary Accident Insurance

PDF IconAccidental Injury Plan Coverage

Critical Illness Insurance

PDF IconCritical Illness Insurance

PDF IconCritical Illness Plan Coverage

PDF IconNew Cigna Rate Sheet

Hospital Indemnity Insurance

Hospital Indemnity Insurance

PDF IconHospital Care Coverage Plan

How to file a claim

Online Claim Forms

PDF IconHow to file a claim for - Accident, Hospital & Critical Illness

PDF IconAccident Claim Form

PDF IconCritical Illness Claim Form

Hospital Indemnity Insurance

PDF IconLife Insurance

PDF IconAD&D - Accidental Death & Dismemberment Insurance 

Short Term Disability

Online STD Claim Form

PDF IconSTD Claim Form

Long Term Disability

Online LTD Claim Form

PDF IconLTD Claim Form

Retirement Plans:

Empower (fka: Great West) 457 Forms

Empower (Great West) 457 Enrollment Booklet

Empower (Great West) 457 Plan Enrollment Form

Empower (Great West) 457 Plan Change in Contribution Form

PDF IconEmpower (Great West) 457 Plan - Employee Name/Address Change

Empower (Great West) 457 Plan - Beneficiary Designation Form

MERS Forms

MERS Defined Benefit Pension - Address Change/Name Change Form

Other Information:

Livingston County Flexible Benefits

PDF IconVacation Purchase Plan

PDF IconVacation Purchase Plan Acknowledgement Form

Tuition Reimbursement 

Open Enrollment