Health Forms
Please Note: In order to view and print the following forms, you must have the Adobe Acrobat Reader installed on your computer. If you
do not have the Adobe Acrobat Reader Software and wish to download it, you may do so by clicking on the image below.
Once your forms have been completed, signed and scanned, they may be sent securely via our Secure Document Uploads page which is available on the Benefit Inquiry Site. Click here for information on how to sign up for a BIS account or click here to login.
- Delta Dental and Vision Retiree Election Form (ACTION REQUIRED BY 11/22/24)
- Aetna Claim Form
- Health Care Enrollment Form / Coordination of Benefits
- Beneficiary Designation Form
- Change of Address Form
- Credit Card On-File Authorization Form Credit Card Payments Q&A
- CVS Caremark Mail Service Order Form
- Direct Debit Authorization Form
- Pension Deduction Authorization Form
- Spouse Employment Information Form
- Statement for Loss of Time Benefits Form
- Supplemental Benefit Account Reimbursement Request Form
- Supplemental Benefit Account Upload Procedure