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

Blue Cross Blue Shield COVID-19 Testing Membership Reimbursement Form

Medco Mail Order Rx Form

HDHP - Getting to Know Your High Deductible Health Plan

HDHP - Non-Union

2022 Waiver of Coverage Form

2023 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 Contribution Amount

HSA Reimbursement Form

HSA - Winning with an HSA

HSA - 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

New York Life Evidence of Insurability Form (EOI)

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)

New York Voluntary Short and Long Term Disability Evidence of Insurability Form (EOI)

CIGNA Accident Insurance

Voluntary Accident Insurance

Accidental Injury Plan Coverage

CIGNA Critical Illness Insurance

Critical Illness Insurance

Critical Illness Plan Coverage

New Cigna Rate Sheet

CIGNA Hospital Indemnity Insurance

Hospital Care Insurance

Hospital Care Coverage Plan

How to file a claim through CIGNA

Online Claim Forms

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

Accident Claim Form

Critical Illness Claim Form

Retirement Plans:

MERS Forms

MERS Frequently Asked Questions

MERS Defined Benefit Plan

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 Plan

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

MERS Hybrid Pension and Defined Contribution Pension - Beneficiary Change Form

MERS Defined Contribution Plan

MERS Budgeting

MERS Debt Management Strategies

MERS Financial Goals Worksheet

Nationwide 457 Enrollment Booklet

457(b) Plan - Brochure for catch up

Nationwide 457 Enrollment Form
Nationwide 457 Payroll Authorization Card

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