Benefit Forms

Health Plan Information: 

Medical Insurance Forms

Blue Cross Blue Shield Member Application for Payment Consideration

Blue Cross Blue Shield Prescription Drug Reimbursement Claim Form

Medco Mail Order Rx Form

HDHP - Getting to Know Your High Deductible Health Plan

HDHP - HDHP Non-Union

2019 Waiver of Coverage Form 

2020 Waiver of Coverage Form

Blue Cross Blue Shield Online Visits (Formally Amwell)

FAQs about online visits
What is an online visit?

Healthcare Bluebook - Transparency Tool

Cost Quality Flyer
Go Green Rewards

NAVIA (Health FSA & Dependent Care Accounts)

Debit Card Flyer
Flexible Spending Account Worksheet
Flexible Spending Account Navigating My Benefits

Flexible Spending Account Claim Form

Health Equity- Health Savings Account & Limited Purpose FSA

HSA - Getting the Most Out of Your Health Savings Account

Changing your HSA Deductions

HSA - Winning with an HSA
HSA - Frequently Asked Questions

Vision Plan Information

Eyemed Employee Portal

Benefit Summary

Creating a login online

EyeMed FAQs

Freedom Pass

Hearing Discounts

Text Alerts

Membership Perks

Out-of-Network Claim Form

Nationwide Pet Insurance
Pet Insurance Benefit Video /Enrollment Page

My Pet Protection Plan 
Plan 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
Cigna Health Advocacy Services
Cigna Discounts and Programs- No additional Cost! 

Accident Insurance

Accidental Injury Plan Coverage

Critical Illness Insurance

Critical Illness Plan Coverage
Rates

Hospital Indemnity Insurance

Hospital Care Coverage Plan

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

Accident Claim Form
Critical Illness Claim Form
Hospital Indemnity Insurance

Online Claim Forms

Life Insurance

AD&D - Accidental Death & Dismemberment Insurance 

Short Term Disability 

STD Claim Form

Online STD Claim Form

Long Term Disability

LTD Claim Form

Online LTD Claim Form

Retirement Plans:

Empower (fka: Great West) 457 Forms  

Empower (Great West) 457 Plan - Employee Change Form

Empower (Great West) 457 Plan - Employee Name/Address Change
Empower (Great West) 457 Plan - New Enrollment Form
Empower (Great West) 457 Plan - Beneficiary Designation Form

Empower (Great West) 457 Plan - Separation from Service Withdrawal Request

MERS Forms

MERS Frequently Asked Questions

MERS Defined Benefit Pension - Address Change/Name Change Form

MERS Defined Benefit Pension - Beneficiary Change Form

MERS Health Care Savings Program - Address Change/Name Change/ Beneficiary Change Forms

MERS Hybrid Pension and Defined Contribution Pension - Address Change/Name Change Form

MERS Hybrid Pension and Defined Contribution Pension - Beneficiary Change Form

Nationwide 457 Forms

Nationwide 457 Plan - New Enrollment Form

Nationwide 457 Plan - Employee Change Form

Public Safety - Tax Free Premiums

Nationwide Fixed Account

Time and Compounding

457(b) Plan - Brochure for catch up

Nationwide 457 Plan - Distribution Request Form

Other Information:

Livingston County Flexible Benefits

Flexible Benefits Plan

Vacation Purchase Plan

Vacation Purchase Plan Acknowledgement Form

Cafeteria Plan Amendment

Tuition Reimbursement 

Employee Tuition Reimbursement

Open Enrollment

2019 Open Enrollment Webinar