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