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Forms

Home/Resources/Forms
FormsEBAdmin2023-02-14T03:04:05+00:00

Here you’ll find the forms you need to manage your benefits. Download the forms by clicking on the links. You can also request a hard copy of any form by contacting the Benefits Support.

Medical Forms
COVID-19 At-Home Test Direct Reimbursement Claim Form PDF
Dental Forms
Delta Dental PPO Claim Form PDF
Cigna Dental PPO Claim Form PDF
Life, Disability & Voluntary Benefit Forms
Unum Long Term Disability EOI Form PDF
Unum Long Term Disability EOI Form Spanish PDF
Unum STD Claim Form PDF
Unum LTD Claim Form PDF
Unum Supplemental Life EOI Form (001 Dept Heads, Service Center Employees) PDF
Unum Supplemental Life EOI Form (002 Nurses, Therapists) PDF
Unum Supplemental Life EOI Form (003 All Other Eligible Employees) PDF
Voluntary Benefits Claim Form (Critical Illness, Accident Hospital Indemnity) PDF
Other Forms
Emergency Fund Voluntary Donation Authorization PDF
Leave of Absence Request Form PDF

Resources

  • Benefits Support
  • Mobile Apps
  • Contacts
  • Forms
  • FAQs
  • Guides, Summaries and Flyers
  • Legal Notices
  • Video Library
  • Admin Login

Benefit Basics

  • Benefits Quick Glance
  • Eligibility
  • New Hire Enrollment
  • Life Changes
  • Ask ALEX
  • Health Care Reform

Health

  • Medical
  • Prescription Drug Benefits
  • Mental Health Support
  • Preventive Care
  • Health Savings Account
  • HealthComp
  • Telemedicine Through Teladoc
  • Telemedicine Through 98point6
  • Wellvolution
  • Voluntary Group Accident
  • Voluntary Critical Illness
  • Voluntary Hospital Indemnity
  • Dental
  • Vision
  • COBRA Continuation Coverage
  • Medicare Information

Financial Protection