Forms and Brochures

2020 It's Your Choice website

2020 It's Your Choice Decision Guide

2020 Health Plan Search by County

2020 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

2019 Health Insurance Information

2020 HSA Website

ConnectYourCare Employee Website

HSA Resources Page (ConnectYourCare)

2020 HSA Enrollment Application

HSA Beneficiary Designation

HSA Claim Form

HSA Eligible Expenses Flyer

2019 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

VSP Vision Website

VSP Vision Application​

VSP Vision Brochure​

Delta Dental Website

2020 Plan Summary and Comparison

2020 Delta Dental Employee Flyer

Delta Dental Application

Delta Dental Continuation/Retiree Form (employer section must be completed by agency)

AD&D Application

AD&D Plan Summary

Zurich Travel Assist Brochure

CyberScout Identity Theft Brochure

AD&D Beneficiary Designation Form

Accident Plan Informational Website

How to File a Claim

Beneficiary Designation (same form used for both your WRS and State Group Life Insurance accounts)​​

Accident Insurance Coverage Benefits

Travel Assistance Benefits

Identity Theft Protection Benefits

Accident Plan Continuation Form

2020 Plan Information

2020 Pre-Tax Savings Plan Website (ETF)

ConnectYourCare Website

Open Enrollment Appeal Form​

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

​ 2019 Plan Information

2019 ERA Website

Health Care FSA Application

Dependent Care FSA Application

Limited Purpose Health Care FSA Application

Parking and Transit Application

Plan Correction Request Form

Change of Election Form

ERA Participant Guide

All ERA-related forms and brochures available on the TASC website

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

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