Benefits

BENEFITS

• HEALTH
  • BCBS Enrollment/Change Form (2023)
  • H.S.A. Enrollment/Change Form (2023)
  • H.S.A. Financial Institution Designation
  • Health Insurance Renewal Memo (Fire) (2023)
  • Health Insurance Renewal Memo (Police) (2023)
  • Health Insurance Renewal Memo (DPW) (2023)
  • Health Insurance Renewal Memo (USW and Non Union) (2023)
  • Declaration of Health Coverage

DENTAL

NEDD Enrollment/Change Form

• NEDD DPW Group Plan
• NEDD Non Union Group Plan
• NEDD USW Group Plan

• LIFE INSURANCE
  • UNUM Enrollment/Change Form
  • Short Term Disability Claim Form
  • UNUM Life Beneficiary Form
  • UNUM Voluntary Life Enrollment/ Change Form (only for New Hires or during open enrollment Jan-Mar annually)
  • Portability Form (Retirees or Separations)
  • UNUM Life, STD and ADD policy
  • UNUM Voluntary Life Policy
• WORKERS COMPENSATION
  • General First Report and Claims Information (Note Police and Fire Use Specific Tabs)
    
    
• DIRECT DEPOSIT
  • Direct deposit form