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 - Non-Union

2020 Waiver of Coverage Form

2021 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

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

HSA - 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

Voluntary Benefits:

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

Voluntary Accident Insurance

Accidental Injury Plan Coverage

Critical Illness Insurance

Critical Illness Insurance

Critical Illness Plan Coverage

New Cigna Rate Sheet

Hospital Indemnity Insurance

Hospital Care Insurance

Hospital Care Coverage Plan

How to file a claim

Online Claim Forms

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

Accident Claim Form

Critical Illness Claim Form

Hospital Indemnity Insurance

Life Insurance

AD&D - Accidental Death & Dismemberment Insurance 

Short Term Disability

Online STD Claim Form

STD Claim Form

Long Term Disability

Online LTD Claim Form

LTD 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

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

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 Enrollment Booklet

457(b) Plan - Brochure for catch up

Nationwide 457 Enrollment Form

Nationwide 457 Contribution Change Form

Nationwide 457 Name/Address/Beneficiary Change Form

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