Flexible Benefit Forms
Adobe PDF
Microsoft Word
External Web Link
| Benefits Forms (General) | ||
| Change of Address Form | ||
| Qualifying Change In Status Form | ||
| Military Differential Pay Form | ||
| Benefit Continuation Form | ||
| Retiree Dental Enrollment Form | ||
| Disability Forms | ||
| Disability Claim Packet - State of Georgia | ||
| Disability Evidence of Insurability Form | ||
| Medical History Statements - Web page for policyholders | ||
| Health Savings Account Forms | ||
| Beneficiary Form | ||
| Enrollment Package | ||
| Payroll Change Form | ||
| Legal Forms | ||
| Signature LegalCare Claim Form | ||
| Life/AD&D Forms and Conversion/Portability Information | ||
| Conversion Information and Form | ||
| Portability Information and Form | ||
| Specified Illness Forms | ||
| Evidence of Insurability Form | ||
| Beneficiary Form | ||
| Claim Form | ||
| Spending Account Forms | ||
| Claim Form for Dependent Care Account | ||
| Claim Form for Health Care Account | ||
| Vision Forms | ||
| Vision Dependent Enrollment Form | ||
| Long Term Care | ||
| Election to Continue Long Term Care Insurance Coverage Form | ||


