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Forms

Active Employees

• BCPS Enrollment/Change form
• Carefirst Dental Claim Form
• Carefirst Major Medical Claim Form
• Dependent Student Certification Form
• Domestic Partner Benefits - Active Employees
• Express Scripts Prescription Drug Claim Form
• FSA Enrollment form
• Flex. Spending Account Automatic Deposit Auth. Agmt.
• Flex. Spending Account claim form
• HIPAA Complaint Form
• MetLife Enrollment/Change Form
• Open Enrollment Dependent Eligibility Verification Form
• MetLife Statement of Health
• MetLife Beneficiary Designation
• Payroll Forms
  • Direct Deposit form
  • W-4 Tax Withholding form
  • Address/Name Change form
  • 457(b) Salary Reduction Agreement
  • 403(b) Salary Reduction Agreement
  • 403(b) Approved Annuity and Mutual Fund Companies
• State Retirement Forms
  • Application for Membership
  • Designation of Beneficiary
  • Request to Purchase Previous Service
  • Estimate for Service Retirement Allowance

Retired Employees

• BCPS Retirees' Enrollment/Change Form
• Carefirst Medicare Application
• Domestic Partner Benefits - Retiree Only
• Retiree Beneficiary Designation Form
• Retiree Change of Name/Address Form
• State Retirement Agency Retirees Change of Address Form