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Auditor-Controller
Gere W. Sibbach, CPA
Auditor-Controller

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 > County Home Page > Auditor-Controller > County Forms Library > Health, Dental and Vision Benefit Forms

Health, Dental and Vision Benefit Forms

Health Benefit forms need to be printed, signed and sent to the appropriate department.

Please read all instructions associated with selected forms. Be sure to make photocopies of all forms for your personal records. If form is more than 1 page, we suggest you print on both sides of the paper. Once forms are completed, give original to your department's payroll clerk for processing. Please call Risk Management at 781-4301 if you have any questions.

PERS Health Benefit Plan Enrollment Form (HBD-12)

PERS Declaration of Health Coverage (HB-12A)

Aetna Enrollment/Change Form

Delta Dental Enrollment/Change Form

VSP (Vision Service Plan) Enrollment/Change Form