Forms

Health and Dental Insurance

  1. Cigna CDHP with HSA SBC (PDF)
  2. Cigna CDHP Benefits Comparison FY19 (PDF)
  3. Health and Dental Waiver (PDF)
  1. Heath and Dental Benefits Comparison Chart (PDF)
  2. Delta Dental Enrollment-Change Form (PDF)

Health Savings Account (HSA)

  1. Health Savings Enrollment Form (PDF)
  1. Health Equity Beneficiary Form (PDF)

Flexible Spending

  1. Flexible Benefits Enrollment Packet (PDF)
  1. Flexible Benefits Claim Form (PDF)

Virginia Retirement System

  1. VRS Beneficiary Continuation Form (PDF)
  2. VRS Beneficiary Designation Form (PDF)
  1. Hybrid Designation of Beneficiary Form (PDF)

Deferred Compensation (457/401)

  1. 457 Beneficiary Designation Form (PDF)
  2. 457 Contribution Change Form (PDF)
  3. 457 Employee Enrollment Form (PDF)
  1. 457 Plan Investment Options (PDF)
  2. 401 Employee Enrollment Form (PDF)

Optional Life Insurance

  1. Optional Life Brochure (PDF)
  2. Group Life Insurance Evidence of Insurability (PDF)
  1. Enrollment Application Optional Group Life (PDF)

Sick Leave Bank

  1. Sick Leave Bank Charter (PDF)
  1. Sick Leave Bank Enrollment and Termination (PDF)