Forms

AD & D - Hartford

• Contract / Rates / Application

Catastrophic Leave

• Catastrophic Leave Policy
• Catastrophic Leave Request
• Catastrophic Leave Donation

Commute Reimbursement

• Commute Expense Reimbursement Account (CERA) guidelines
• CERA Enrollment Form
• CERA Claim Form

Dental Insurance - Oregon Dental Service (ODS)

• ODS Benefit Summary
• Incentive Policy Benefit Book
• Traditional Policy Benefit Book
• Insurance Enrollment/change of information Form
• Dental Claim Form

Deferred Compensation

• Payroll Deduction/Change Form

FMLA / OFLA

• FMLA / OFLA Summary 
• FMLA / OFLA Request & Certification Form
• Release to Return to Work Form

Health Insurance - Healthcare Management Administrators (HMA)

• AFSCME Benefit Summary
• IAFF Benefit Summary
• PCEA Benefit Summary
• SPEU Benefit Summary
• Unrepresented/Confidential Benefit Summary
• Insurance Enrollment/change of information Form
• Claim Reimbursement Form
• HMA Online Instructions 
• Walgreens Preferred Medication List 
• Walgreens Reimbursement Form
• Walgreens Mail Service

Kaiser Permanente Insurance

• Kaiser Permanente Benefit Summary
• Insurance Enrollment/change of information Form

Life Insurance - Standard Insurance

• Contract - General Employees
• Contract - Fire and Police
• Beneficiary Change Form
• Voluntary Insurance Rates

Long Term Disability

• AFSCME Contract
• IAFF Contract
• PCEA Contract
• SPEU Contract
• Unrepresented/Confidential Contract

Military Leave Donation

• Military Leave Donation Policy
• Military Leave Q&A
• Request to receive 
• Military Leave Donation Form

Misc Forms

• Affidavit of Dependency
• Coordination of Benefits
• Student Certification Form
• Direct Deposit Form
• Gold's Gym Flyer
• Pre-tax Authorization Form
• YMCA Flyer

Personal Choice Account

• PCA Enrollment Application
• Direct Deposit 
• Dependent Care Reimbursement Form
• Health Care Reimbursement Form
• Status Change Form
• Eligible Medical Expenses
• Eligible Over the Counter Expenses
• Eligible Reimbursable Expenses

Public Employees Retirement System (PERS/OPSRP)

• PERS Beneficiary Form
• Individual Account Program (IAP) Beneficiary Form

Rates

• Active employee
• Retiree / COBRA

Vision Insurance

• Vision Benefit Summary
• Insurance Enrollment/change of information Form
• Vision Claim Form