Benefit Forms

• Health, Prescription, Vision & 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 Account Enrollment Form

Tab through to complete the form. Print, sign and return to the Human Resources Benefits Division.

• Retirement Plans-PERS or PFRS 
• Member Benefit Online Services

• Horizon Student Verification Information
• IAA Claim Form

• Employee Benefits
• Health Benefits
• Retirement Plan Information
• Voluntary Benefits
• Group Medical Insurance Eligibility
• Insurance Timelines
• Benefit FAQs
• Plan Administrators

• Horizon Dental Enrollment form
• Affidavit Of Dependency
• IAA Summary of Benefits