Forms

Forms

• 1095-C Forms
• Adoption Assistance Form
• Caremark Prescription Mail Order Form
• Claim Forms:
  • Prescription Reimbursement Claim Form
  • Aetna Dental Claim Form
  • Health Care Flexible Spending Account Claim Form (WageWorks)
  • Day Care Flexible Spending Account Claim Form (WageWorks)
• Helping Hands PTO Request Form
• Disabled Dependent Form for Medical:
  • Disabled Child Form (UHC)
  • Disabled Dependent Form (Aetna)
  • Disabled Dependent Form (Quantum)
• Disabled Dependent Physician Statement (Aetna)
• Documentation Cover Sheet
• Paper Handbook Election Form
• Paid Parental Leave Form
• Prudential EOI Form
• Webforms:
  • Submit an appeal to the Benefits Department
  • Submit a question to the Benefits Department