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

Blue Cross Blue Shield COVID-19 Testing Membership Reimbursement Form

PDF IconMedco Mail Order Rx Form

PDF IconHDHP - Getting to Know Your High Deductible Health Plan

PDF IconHDHP - Non-Union

2022 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

HSA - Changing your HSA Contribution Amount

HSA Reimbursement Form

PDF IconHSA - Winning with an HSA

PDF IconHSA - Frequently Asked Questions

Voluntary Benefits:

Nationwide Pet Insurance

Pet Insurance Overview
Avian & Exotic Pet Plan
Pet Insurance - Frequently Asked Questions
Pet Rx Express - Frequently Asked Questions
Upcoming Rate Adjustments - Frequently Asked Questions

Pet Insurance Benefit Video /Enrollment Page

Member Portal - You can use this to:

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

New York Life Group (formally known as CIGNA)

New York Life Online Account Registration Instructions

New York Life Advocacy Services

My Secure Advantage Program

New York Life Group (formally known as CIGNA) Life Insurance

Term Life Insurance through New York Life Group

Voluntary Life Insurance through New York Life Group

Short and Long Term Disability through New York Life Group (formally known as CIGNA)

How to File Your Disability Claim with New York LIfe Group (formally known as CIGNA)

CIGNA Accident Insurance

PDF IconVoluntary Accident Insurance

PDF IconAccidental Injury Plan Coverage

CIGNA Critical Illness Insurance

PDF IconCritical Illness Insurance

PDF IconCritical Illness Plan Coverage

PDF IconNew Cigna Rate Sheet

CIGNA Hospital Indemnity Insurance

Hospital Care Insurance

PDF IconHospital Care Coverage Plan

How to file a claim through CIGNA

Online Claim Forms

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

PDF IconAccident Claim Form

PDF IconCritical Illness Claim Form

Retirement Plans:

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