Here in the Benefits Department, we want to make the task of obtaining and completing health plan forms as easy as possible. To that end, we have included many of our forms here on the website for convenient access. Several pieces have been created in a format you can complete online, which saves time and enhances legibility. Please check our site frequently, as we will be adding more forms in the coming months.

Attention– When submitting forms, we respectfully request the entire form be completed and typed! To type in the forms listed below, click on the link you need, and a new window will open.

~If using the “Internet Explorer” browser, once it has opened in the new window, you can start filling it out from there.

~If using the “Firefox” browser, once it has opened in the new window you will see this↓  below the address bar.  Click the “Open With Different Viewer”, then select “Open with- Adobe Reader” and now you will be able to fill out the form

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  • Benefits Guide 2025
  • Application Change Waiver Form
  • Additional  Info Required by COBRA(formerly GIP 7)
  • Cafeteria Plan Election Form, Per Pay Stipend
  • Cafeteria Plan Election Form, Per Month Stipend
  • Change in Employee Status (formerly GIP6)
  • Hartford Basic Life Enrollment Form
  • Hartford Beneficiary Form
  • Hartford Supplemental Life Enrollment Form
  • Mutual Health Services Claim Form