Claims / Medical Forms

•  Beneficiary Form  Core Life and AD & D Insurance Beneficiaries
•  Benefit Enrollment/Change/Decline
•  GT Bray Membership Reimbursement Form
•  Flexible Reimbursement Claim Form 2012
•  Flexible Reimbursement Claim Form 2011
•  ID Card Request & Address Change Form
•  Manatee Choice Acknowledgement 
•  Medical-Dental Claim
•  Medical History Statement
•  Medication Prior Authorization Form
• Pre-Existing Condition Acknowledgement
•      Request for CLAIMS REVIEW

Financial / Admin Forms

• Fidelity Application with Beneficiary
• Fidelity Instructions
• Fidelity Transfer-Rollover Form
•  Hartford Change Form
• Hartford Withdrawal-Transfer Form
• ICMA Change Form
• ICMA Transfer
• Nationwide Enrollment-Change Application

Program Forms

•  Exercise Management Program
•  Exercise Management Progress Report
•  Fitness Center Membership Form
•  Group Fitness Registration Form
•  Healthy Baby Program Form 
• Weight Reduction Program 

Qualifying Event Forms for Plan Year 2013

Qualifying Event Time Period is 9/1/11 to 8/31/12

Click on each link below to download a PDF version of the form.

•  Diabetes Qualifying Form
•  Wellness Profile Exam Child
•  Wellness Profile Exam Female
•  Wellness Profile Exam Male