Payroll Forms & Publications

Medical

• Plan Comparison Information
• 2017 Enrollment Guide
• 2017 Medical Enrollment/Change Form
• Dependent With Disabilities Certification Form
• Request for an Appeal
• Verification of Dependents
• Authorization for Deduction to Health Savings Account
• Tobacco & Spousal Surcharge Attestation Form
• Tobacco & Spousal Surcharge Help Sheet
• Spousal Plan Calculator

Medical Claim Forms

• Uniform Medical & Vision Claim Form
• Group Health Classic and Value Medical & Vision Claim Form

Prescription Plans

• Uniform Online Pharmacy
• Kaiser WA Online Pharmacy
• Kaiser WA Prescription Claim Form

Life Insurance

Visit MetLife webpage for more information.

Long-Term Disability

• Long-Term Disability Benefit Booklet
• Long-Term Disability Enrollment/Change Form
• Long-Term Disability Evidence of Insurability Form

Flexible Spending

• 2017 Flexible Spending & Dependent Care Enrollment Form
• Flexible Spending/Dependent Care Assistance Claim Form
• 2017 FSA Enrollment Guide
• 2017 DCAP Enrollment Guide
• Recurring Day Care Claim Instruction Guide

VEBA

• VEBA Enrollment Kit
• VEBA Claim Form
• VEBA Direct Deposit Enrollment Form
• VEBA Election of limited VEBA Plan Coverage Form for those with HSA accounts
• VEBA Automatic Premium Reimbursement Form for retirees
• VEBA Investment Allocation Change Form
• VEBA Account Change Form

IRS Forms

• 2017 W-4 Form

Miscellaneous Forms

• Employee Address Change Form
• Direct Deposit Form
• Administrative/Exempt Employee Request to Extend Excess Leave Form