Employee Forms

All forms listed below are in PDF format, and require the Acrobat Reader to be installed on your computer. Click here to download the Free reader. Also, some files are quite large and may take a few minutes to open if you are using a dial up internet connection.

Jump to:

• Health Benefit Forms
• Savings Club
• Tax Forms

Health Benefit Forms

Medical

• Employers Resource Management Claim Form
  • English
• Framework Claim Form
  • English

Employers Resource Management Sponsored Medical Plan Enrollment Forms

• Kaiser
  • English
• PacifiCare
  • English
• Framework
  • English Spanish

Accident Claim Form

• Accident Claim Form
  • English

Dental

• Dental Claim Form
  • English

Prescription Drug Claim Forms

Employers Resource Benefit Trust/Envision RX

• Claim Form
  • English
• Mail Order Form
  • English

FSA/HRA

• Reimbursement Request Form
  • English
• Medical Necessity Form
  • English

Life Insurance

• Beneficiary Designation Form
  • English
• Supplemental Life Insurance Form
  • FORM A: Additional Life Insurance Enrollment Form
    • English
  • FORM B: Additional Life Insurance Medical History Statement
    • English
      
      

Savings Clubs

• Savings Club
  • English
    
    

Tax Forms

• W-4 Form
  • English Spanish