Standard Forms

Administrative Forms

2020 Eligible Expenses for Use with HSA Funds

2021 Eligible Expenses for Use with HSA Funds

Application to Convert Group Life Insurance

Dependent Eligibility

Direct Payments of Self-Funded Invoices

Group Options Subscriber Application

HIPAA Disclosure Authorization Form

MEC Plan Subscriber Application

Reliance Standard Beneficiary Designation

Reliance Standard Group Life Evidence of Insurability Form​​​​​

Reliance Standard Voluntary Life Claim Form

Report of Salary Changes

Report of Terminations 

SET SEG Beneficiary Change

SET SEG Change Form

SET SEG Fully-funded Auto Pay

SET SEG Subscriber Application

SET SEG Subscriber Application Dental & Vision Only

Travel Accident Beneficiary 

Waiver of Group Health Benefits

Claim Forms

ADN Dental Claim Form

ADN Vision Claim Form

CIGNA Life

Group Life Insurance Claim

Hospital Indemnity Claim Report

Long-Term Disability Claim Statement

Reliance Standard Accelerated Benefit

Reliance Standard Group Life & Accidental Death and Dismemberment

Reliance Standard Long-Term Disability

Reliance Standard Short-Term Disability

Short-Term Disability Claim Statement

Standard Insurance Waiver of Premium

Travel Accident Death

Travel Accident Accidental Death and Dismemberment

UNUM Group Life & Accidental Death

Voluntary Products

Voluntary Benefits