Forms


The following forms are available through Adobe Reader. Contact your Post Tax Benefits Coordinator to check enrollment eligibility or to acquire additional forms. Not all plans are available in each agency. Go to the Available Benefits section for your agency for a list of approved programs.

Enrollment Applications
Change, Claim and Conversion Forms
Payroll Deduction Authorization Forms
Refund Request Forms
Miscellaneous Deduction Payment Forms

 

Brochures


AFLAC Accident Insurance
Biweekly Agencies/Monthly Agencies


LINA (Alta) Group Term Life Insurance


LINA (Alta) Long Term Disability Insurance
Biweekly Agencies/Monthly Agencies


ARAG Prepaid Legal Insurance


Colonial Cancer & Intensive
Care Insurance


Colonial Medical Bridge 3000 Plan

Conseco Solutions Life Choices Series


Hartford Accidental Death & Dismemberment Plan (AD&D)


Hartford Group Term Life Insurance


Hartford Long Term Disability Insurance


Humana Critical Illness Insurance
Critical Illness Video
Agency for Persons with Disabilities
Department of Revenue
Department of Children & Families


Long Term Care At a Glance


Marsh Voluntary Benefits Auto & Home

Hyatt MetLaw Plan

Department of Children & Families
Agency for Persons with Disabilities
Department of Transportation
Department of Revenue

 

 

 

Reliance Standard Life Insurance

Agency for Persons with Disabilities
Department of Children & Families
Department of Agriculture & Consumer Services
Department of Elder Affairs
Department of Juvenile Justice
Department of Highway Safety & Motor Vehicles
Department of Law Enforcement
Department of Revenue
Department of Transportation

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Enrollment Applications

LINA (Alta) Group Term Life Insurance
Health Questionnaire (required outside an open enrollment period)

ARAG Prepaid Legal Insurance

Hartford Accidental Death & Dismemberment

Humana Critical Illness Insurance

Hyatt Prepaid Legal Expense Plan
Department of Children & Families
Agency for Persons with Disabilities
Department of Revenue
Department of Transportation

LINA (Alta) Long Term Disability Insurance
Health Questionnaire (required outside an open enrollment period)

Hartford Group Term Life Insurance

Hartford Long Term Disability

Reliance Standard Life Insurance
Department of Children & Families
Department of Juvenile Justice
Department of Highway Safety & Motor Vehicles
Department of Law Enforcement
Department of Revenue
Department of Transportation

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Change Forms

LINA (Alta) Group Term Life Beneficiary Designation

Hartford Accidental Death & Dismemberment Beneficiary Designation

Reliance Policy Change

Hartford Group Term Life Beneficiary Designation

Humana Critical Illness Policy Change

Reliance Group Term Life Beneficiary Designation

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Conversion Forms

LINA (Alta) Group Term Life

Hartford Accidental Death & Dismemberment

Hartford Long Term Disability

Hartford Group Term Life

Reliance Portability Application

Cigna (formerly Alta) Group Term Life Conversion Form

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Claim Forms

LINA (Alta) Long Term Disability

LINA (Alta) Group Life Dismemberment

LINA (Alta) Group Life Waiver of Premium

Hartford Group Term Life

LINA (Alta) Group Life

Hartford Accidental Dismemberment

Hartford Long Term Disability

Humana Critical Illness

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Payroll Authorization Forms

Florida College Prepaid Plan Deduction Form (Biweekly)

Florida College Prepaid Plan Deduction Form (Monthly)

PRD Authorization - DC

PRD Authorization - DJJ

PRD Authorization - DOEA

PRD Authorization - DOR

PRD Authorization - FDLE

Florida College Investment Plan Deduction Form (Biweekly)

Florida College Investment Plan Deduction Form (Monthly)

PRD Authorization - DCF/APD

PRD Authorization - DOACS

PRD Authorization - DOH

PRD Authorization - DOT

PRD Authorization - HSMV

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Refund Request Forms

Request for Refund- DC

Request for Refund- DCF/APD

Request for Refund- DJJ

Request for Refund- DOACS

Request for Refund- DOEA

Request for Refund- DOH

Request for Refund- DOR

Request for Refund- DOT

Request for Refund- FDLE

Request for Refund- HSMV

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Miscellaneous Deduction Payment Forms

Miscellaneous Deduction Payment - DC

Miscellaneous Deduction Payment - DCF/APD

Miscellaneous Deduction Payment - DJJ

Miscellaneous Deduction Payment - DOACS

Miscellaneous Deduction Payment - DOEA

Miscellaneous Deduction Payment - DOH

Miscellaneous Deduction Payment - DOR

Miscellaneous Deduction Payment - DOT

Miscellaneous Deduction Payment - FDLE

Miscellaneous Deduction Payment - HSMV

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