Benefit Forms

Benefit Forms

 Benefit Forms

Health Plan Information: 

Medical Insurance Forms

Blue Cross Blue Shield Member Application for Payment Consideration Medco Mail Order Rx Form

Blue Cross Blue Shield Online Visits (Formally Amwell)

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 Navigating My Benefits

Vision Plan Information

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
Accidental Injury Plan Coverage
Critical Illness Insurance
Critical Illness Plan Coverage
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 Name/Address Change
Empower (Great West) 457 Plan - New Enrollment Form
Empower (Great West) 457 Plan - Beneficiary Designation Form

MERS Forms

MERS Defined Benefit Pension - Address Change/Name Change Form

Other Information:

Livingston County Flexible Benefits

Tuition Reimbursement 

Open Enrollment