Benefit Forms

While most benefits are only available for enrollment during the annual enrollment period, there are several benefits available for enrollment at anytime. Additionally, should you have an event such as a birth or adoption of a child, loss of insurance coverage from a parent or spouse, marriage, divorce, or another life change, please reach out to HR for directions on steps you need to take. If you are unsure or have questions, please reach out. 

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Download and review the 2024 Benefits Booklet

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Benefit Enrollment Forms

INSTRUCTIONS: Forms may be completed one of three ways:

1. Print the form, fill it out by hand, and turn it into HR.
2. You can complete the form using the computer, save it, print it, sign it, and turn into HR.
3. Complete and submit the form online by SAVING it to your desktop. Re-open the form, complete it, and save again. Depending on your system set up, you may not be able to sign the form (not required). Some systems also do not allow you to use the SUBMIT button. If this is the case, just save each form you need to complete and attach them to an email addressed to [email protected]. If the SUBMIT button does work, you will see a window pop up and ask you to attach it to email. You may send forms one at a time.

• Open Enrollment Forms
• Rates & Voluntary Coverage Info
• Anytime Enrollment

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• Medical enrollment form*
• Delta Dental enrollment form*
• Willamette Dental enrollment form*
• Life Insurance and AD&D enrollment form* (company paid and voluntary)
• Pet Insurance enrollment* (voluntary)
• Flexible Spending Account enrollment form** (voluntary)​
• Deferred Compensation enrollment (voluntary)
• Critical Illness Insurance enrollment form* Aflac (voluntary)
• Group Accident Insurance enrollment form* Aflac (voluntary)
• Student Loan Repayment Program enrollment (link to info request form)
• YMCA Gym Memberships - email HR for more info

• Aflac Group Policy Overview and Rates
• Aflac Group Accident Coverage
• Kaiser PPO Overview
• Kaiser HMO Overview
• Voluntary Life Insurance Rates

• Pet Insurance enrollment* (voluntary)
• Life Insurance and AD&D enrollment form*  The Standard (company paid and voluntary)
• Student Loan Repayment Program enrollment (link to info request form)
• Deferred Compensation (457b) enrollment Nationwide (voluntary)
• Critical Illness Insurance enrollment form* Aflac (voluntary)
• Group Accident Insurance enrollment form* Aflac (voluntary)
• Hospital Indemnity enrollment form* Aflac (voluntary)
• ATT First Net
• YMCA Gym Memberships - email HR for more info

*Only complete and submit if you need to make changes.
**Required to submit each year.