Benefits forms and applications

• Medical Enrollment Forms
• Flexible Spending Account Forms
• Life Insurance
• Claim Forms
• Beneficiary Designation Forms

Medical Enrollment Forms

• SPS Medical/Dental Change Form
  • If you have a qualified event, you may use this form to:
    • Add/Drop Coverage
    • Add/Drop Dependents
• SPS Documentation Upload   *   You may use this form to upload any necessary documentation after forms have been submitted.

Flexible Spending Account Forms

 

• 2023 FSA and DCA Reimbursement Form
• FSA-DCA Enrollment Form

Life Insurance

• Life Insurance Plan Document
• Voluntary Life & Accident Insurance Application 
• Evidence of Insurability Form
• Voluntary Life & Accident Insurance Beneficiary Form 
• Optional Life Insurance Rates

Claim Forms

• Anthem Claim Form
• CIGNA Dental Claim Form
• CIGNA Medical Claim Form

Beneficiary Designation Forms

• Life and Accident Insurance Beneficiary Designation Form - Employee
• Teachers' Retirement Board Life Insurance Beneficiary Designation Form
• Paraeducator Pension Beneficiary Form - (hired before 7/1/2022)