Active Employees

• BCPS Enrollment/Change Form (Eff. 1/1/13 - 12/31/13)
• Carefirst Dental Claim Form
• Carefirst Major Medical Claim Form
• Carefirst Vision Reimbursement Claim Form
• CIGNA Medical Claim Form
• CIGNA - Transition of Care / Continuity of Care with Mental Health Form
• Domestic Partner Benefits
• Express Scripts Prescription Drug Claim Form
• FSA Enrollment Form (Eff. 1/1/13 - 12/31/13)
• FSA Claim Forms
  • FSA Debit Card Substantiation Form
  • Dependent Claim Form
  • Medical Claim Form
• FSA Over-the-Counter (OTC) Medication Doctor Recommendation Form
  • Important Changes to Your Benefit Account
• FSA Direct Deposit Authorization
• HIPAA Complaint Form
• Open Enrollment Dependent Eligibility Verification Form (Eff. 1/1/13 - 12/31/13)
• Life insurance and PAI (Personal Accident Insurance) Provider (Effective 09/01/09)
  • Prudential Enrollment/Change Form
  • Prudential Beneficiary Designation/Change Form
  • Prudential Short Form Health Statement
  • Certificate for Life & PAI/AD&D
    
• 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 & Pension System
  • State Retirement Forms
  • Application for Membership
  • Designation of Beneficiary
  • Request to Purchase Previous Service
  • Estimate for Service Retirement Allowance