Anthem Medical Claim Form
Anthem Pharmacy Reimbursement Claim Form
Anthem Mail Order Pharmacy Reimbursement Claim Form

Click here to be re-directed to the Medical Benefits page.

Direct Dental Claim Form

Click here to be re-directed to the Dental Benefits page.

VSP Vision Claim Form
Click here to be re-directed to the Vision Benefits page.

FSA Claim Form
Day Care FSA Receipt for Services
Recurring Day Care Claim Form
Direct Deposit Request Form

457 Plan – How To Enroll Online
Roth IRA Payroll Deduction Authorization Form

Click here to be re-directed to the Retirement Benefits page.

To obtain reimbursement for any of these benefits, employees must submit a Benefits Expense Reimbursement Form on SharePoint, along with receipt/proof of payment to the Payroll Department.
**Please note that all reimbursements are considered as taxable.

Pre-Paid Legal Services Membership Application
PTO Sell Back Request Form
Friends Helping Friends PTO Donation Form
Public Service Loan Forgiveness Employment Service Form
Wellness Activity Liability Acknowledgement Form