Insurance Forms
Downloading and Saving a Fillable PDF Form
Fillable PDF forms may be completed and saved using Adobe Acrobat Reader (this software must be loaded on your computer). To accomplish this, you must first save the empty form on your own computer:
--Position your cursor on the form link and click with your right mouse button (do not activate the link and open the form)
--From the menu that pops up, select the Save link as… or similar option in your browser
--You should then be prompted to choose a location to save the file
--Select the location on your own computer or network and click on the Save button
--Once saved, navigate to the file
- Enrollment Change Application — Active Members and COBRA
- Certification of Eligibility for Dependents Placed with Head of Contract by Valid Placement Order
- Dependent Eligibility Certification for Dependent with Expired Placement Order
- Insurance Cancel Request Application
- Dependent Eligibility Verification Documents
- Dental Only Application for Current Members (Retirees and COBRA only)
- HSA Transfer Request Form Instructions
- Basic Term Life/AD&D Insurance Enrollment/Change Application
- Voluntary Accidental Death and Dismemberment Enrollment
- Voluntary Term Life Enrollment Form
- Voluntary Term Life Evidence of Insurability Form
- Voluntary Term Life Beneficiary Designation Form
- Voluntary Term Life Service Request
- Voluntary Term Life Fax Cover Page
- Dismemberment and Loss of Sight Claimant Statement