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Forms Pic.JPG

Paperwork

To get you and your family covered.


Medical, Dental, Vision, and Long Term Disability

Employee Benefits Enrollment Form
  • Enroll in medical, dental, vision, and long term disability insurance

  • Change medical plans (during open enrollment or when you experience a qualifying event)

  • Add/drop dependents

  • Change long term disability plan (during open enrollment)


Flexible Spending Account (FSA)

Flex Plan Enrollment Guide
  • Enroll in the health and/or dependent care FSA

Life and AD&D Insurance


public employees retirement system (PERS)

PERS Plan Choice Guide

Deferred Compensation (ICMA)

457 & Roth Contribution Change Form
401(a) Plan Employee Election
 

Life and ad&D insurance

Reliance Standard Life and AD&D Enrollment Form
Standard Life/AD&D Enrollment/Change Form
  • Enroll or change your life and AD&D insurance coverage through Standard Insurance Company.

Zurich AD&D Enrollment Form
  • Enroll in AD&D insurance coverage through Zurich American Insurance Company.


Life Flight

Group Membership Enrollment Form

Questions?

we’re here to help

Contact Katie Pfitzer at kpfitzer@popud.org