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

2018 Waiver of Coverage Form

2019 Waiver of Coverage Form 

Blue Cross Blue Shield Online Visits (Formally Amwell)

Online Doctor Visits Information

FAQs about online visits

What is an online visit? 

Healthcare Bluebook - Transparency Tool

Cost Quality Flyer

Go Green Rewards

Arcadia Flexible Spending Forms- (Health FSA & Dependent care accounts)

Debit Card Flyer

Flexible Spending Questions and Answers

Flexible Spending Account Worksheet

Flexible Spending Account Enrollment Form

Flexible Spending Account Claim Form

Flexible Spending Account Internet Account Access Login Instructions

Orthodontia Fact Sheet

Over-The-Counter Fact Sheet

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

2018 HSA Limits

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

*NEW 2019* Nationwide Pet Insurance
Pet Insurance Benefit Video /Enrollment Page

My Pet Protection Plan 

Plan Coverage

Plan Summary

Member Portal - You can use this to:

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

*NEW 2019* CIGNA Information/Forms

Cigna Welcome Guide

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
  

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 - Employee Change Form

Nationwide 457 Plan - New Enrollment Form

Public Safety - Tax Free Premiums

Nationwide Fixed Account

Time and Compounding

October 2016 Economic Report

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

2019 Open Enrollment

2019 Open Enrollment Webinar

Open Enrollment Coming Soon!

Open Enrollment Presentation Schedule 

Open Enrollment ESS

CIGNA Example