Enrollment, Change, and Claim Forms (Benefits Plan & Tax-Deferred Investments)

Benefits Enrollment Change Forms

• Cost Share Change Form
• Ben Pay Change Form
• Life Insurance Application
• New Benefits Discount

Claim Forms

• Anthem Mail Order Prescription Form
• Anthem Medical Claims
• Anthem Prescription Claims
• EBMS Dental Claim Form
• Dependent Care Flexible Spending Account
• Health Care Flexible Spending Account

Tax-Deferred Investment Payroll Deduction Change Forms

• 403b
• PERA 401k
• State of Colorado 457 Plan (requires online changes)
• Savings Bond Enrollment Form

 

lk