On this site you may access forms which are available to be viewed and printed. To access any of the following forms, click on the form you are interested in, and then use the print feature in the application it is displayed in. To view PDF files you need to get Adobe Acrobat Reader.
2015-2016 Medical Waiver Form – All employees who choose the medical waiver need to complete a new form yearly.
Wellmark Application– Use this form to change plans at open enrollment
Primary Care Provider Selection Form Plan B or C– Use this form with
Plan B and Plan C
Dental/Vision Enrollment Form– Use this form to make address changes, name changes, cancel coverage, add dependents, or to change plans at open enrollment
VSP Out of Network Claim Form – Use this form if you have an out of network provider
Flexible Spending Accounts
2015-2016 Flex Spending Election Form – Use this form at open enrollment to make
changes to your flex spending accounts or to add a flex spending account
Life Insurance Enrollment Form – Use this form for new hires and to change
Evidence of Insurability Form – Use this form if you want to add additional optional coverage
Coast to Coast Vision Plan
2015-2016 Coast to Coast Vision Plan Enrollment – A new enrollment is required each year of participation
Voluntary Time Schedule Reduction
Check by Mail – authorization form for Simpson to mail your wages
Apply to the Social Security Administration for a new card, provide HR with a copy of the new card to make the change.