Agency Directory Online Services
General Benefits Information
Forms & Brochures
Insurance Premiums
Insurance & Disability Plans
Savings & Retirement Plans
Wellness & EAP
Life Events
Leave Benefits
Employee Self Service Job Aids
This page contains links to benefit applications, brochures and other plan documents. Please note that at hire and during Open Enrollment, employees should use eBenefits to enroll in benefits.
2021 It's Your Choice website
2021 It's Your Choice Decision Guide
2021 Health Plan Search by County
2021 Health Plan Resource Page
Health Insurance Application
Affidavit for Insurance Purposes (if employee or dependent doesn't have SSN)
Navitus Member Portal
Serve You - Prescription Mail Order Vendor
Sick Leave Escrow Application
Sick Leave Credit Conversion Program Brochure
2020 Health Insurance Information
2021 HSA Website
ConnectYourCare Employee Website
ConnectYourCare Marketplace
HSA Resources Page (ConnectYourCare)
HSA Beneficiary Designation
HSA Claim Form
HSA Eligible Expenses Flyer
2020 HSA Website
State Group Life Insurance Page
Life Insurance Application
State Group Life Insurance Beneficiary Designation Form (Used for both SGL and WRS accounts)
State Group Life Insurance Brochure/Plan Certificate
Lifestyle Benefits Summary
Income Continuation Insurance Page
Income Continuation Insurance Application
Income Continuation Insurance Brochure
DeltaVision Website
DeltaVision Application
DeltaVision Continuation Form (bottom of form must be completed by agency)
Guide to Supplemental Vision Benefits
Vision Provider Search
Online Retail Options
Delta Dental Website
2021 Guide to Supplemental Dental Benefits
2021 Plan Summary and Comparison
Additional Dental Benefits Available
2020 Plan Summary and Comparison
Dental Provider Search
Delta Dental Application
Delta Dental Continuation/Retiree Form (employer section must be completed by agency)
Accident Plan Informational Website
How to File a Claim
Beneficiary Designation (same form used for both your WRS and State Group Life Insurance accounts)
Group Accident Certificate of Insurance
Accident Insurance Coverage Benefits
Travel Assistance Benefits
Identity Theft Protection Benefits
Accident Plan Continuation Form
2021 Pre-Tax Savings Plan Website (ETF)
ConnectYourCare Website
myCYC Mobile App from ConnectYourCare
2021 Enrollment Form (all plans)
Change in Status Form (all plans)
Healthcare FSA Claim Form
Dependent Day Care Claim Form
Transit & Parking Claim Form
Transit & Parking Attestation Form
WDC Program Page
Full Enrollment Form
Quick Enrollment Form
Beneficiary Designation
Investment Planning Guide
For more information, see the WDC Website
WRS Summary Page
Beneficiary Designation Alternate
Election to Participate in the Variable Fund
Election to Cancel Variable Fund Participation
Benefit Information Request
Edvest Informational Flyer
Edvest Enrollment Booklet
Payroll Contribution Form