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

NAVIA (Health FSA & Dependent Care Accounts)

Debit Card Flyer
Flexible Spending Account Worksheet
Flexible Spending Account Enrollment Form

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

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

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 - 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