Forms

Benefits Election Form

United Healthcare Medical Enrollment / Waiver Form
United Healthcare Medical Change Form
United Healthcare Claim Form
United Healthcare Pharmacy Reimbursement Claim Form
United Healthcare Mail Order Pharmacy Reimbursement Claim Form

Kaiser COBRA Form
Kaiser Claim Form
Kaiser Student Certification Form
Kaiser Termination Form

Anthem Dental Claim Form

Anthem Vision Claim Form

Mutual of Omaha Life & Disability Enrollment Form
Mutual of Omaha Voluntary Life Enrollment Form
Mutual of Omaha Beneficiary Designation Form
Mutual of Omaha Evidence of Insurability Form
Mutual of Omaha Life & AD&D Claim Form
Mutual of Omaha LTD Claim Form
Mutual of Omaha STD Claim Form – How to File a Claim
Mutual of Omaha Life Conversion Form
Mutual of Omaha Life Portability Request Form
Portability v.s. Conversion Flyer

EOI Form

FSA Enrollment Form
FSA Claim Form Form

Commuter Benefits Enrollment Form
Commuter Benefits Claim Form Form

Benefit Resource Direct Deposit Form

LegalShield / IDShield Enrollment Form
Marin Benefits Claim Form