Human Resources - Employee Benefits
Health, Prescription & Dental Benefit Waiver Form
Medical Enrollment/Change Form
Tab through to complete the form. Use this form for new enrollment and to make changes in coverage. Upon completion submit to Human Resources Benefits Division.
Horizon Dental Enrollment Form
Dental Services Organization (DSO) Enrollment Form
Horizon Vision Enrollment Form
Certification for Dependent Children to age 26
Complete and submit to the Human Resources Benefits Division.
Flexible Spending Account Claim Form
You will need to print this form. Complete and submit directly to Insurance Administrator's of America.
Flexible Spending Enrollment Form
Tab through to complete the form. Print, sign and return to the Human Resources Benefits Division.
Horizon Student Verification Information
IAA Claim Form
Retirement Plan Information
Group Medical Insurance Eligibility
HR-22 Affidavit of Dependency
Application for Retirement PRFS (Updated)
Application for Retirement PERS (Updated)
Application for Disability Retirement PERS (2009)
Application for Disability Retirement PFRS (2009)
Change Retirement Application Form (Updated)
Retirement Facts PERS
Retirement Facts PFRS
Horizon Dental Enrollment/Change Request