Florida Blue Health Insurance Forms/Summaries
- 3769_16-17_BCBS_Summary of Benefits.pdf (274.8 KBs)
- 3900_16-17_BCBS_Summary of Benefits.pdf (237.4 KBs)
- BCBS Employee Enrollment Application.pdf (257.2 KBs)
- RATES 2017-2018 FLORIDA BLUE.pdf (64.9 KBs)
- BCBS Employee CHANGE FORMS.pdf (237.7 KBs)
Standard Dental & Vision Forms/Summaries
- SUMMARY_16-17_DENTAL.pdf (1.2 MBs)
- SUMMARY_16-17_VISION.pdf (700.8 KBs)
- RATES 2017-2018 Dental & Vision.pdf (164.4 KBs)
- Standard Employee Enrollment_Change app.pdf (1.3 MBs)
Miscellaneous Forms
- Deduction Cancellation Request - Deduction Cancellation Request.pdf (198.4 KBs)
- Direct Deposit Form - HDSB-DirectDeposit-20.pdf (309.1 KBs)
- Health Insurance Bank Debit (For Retirees) - health_insur_debit.pdf (10.4 KBs)
- Leave of Absence - LEAVE OF ABSENCE REQUEST revised 2022.pdf (213.3 KBs)
- Leave, Purchase of Sick - leave-purchase_sick.pdf (19.0 KBs)
- Payroll Deduction - Payroll Deduction.exe (497.2 KBs)
- Position Transfer, Inter - position-transfer_inter.pdf (41.3 KBs)
- Position Transfer, Intra - position-transfer_intra.pdf (39.8 KBs)
- Resignation (pdf) - resignation.pdf (61.5 KBs)
- Sick Leave Buyback - sick_lve_buyback.pdf (84.6 KBs)
- Sick Leave Request - Sick Leave Request Form.pdf (63.2 KBs)
- Transaction Routing Request - transaction_routing_request_403b.pdf (78.6 KBs)
- Travel - Out of County (excel) - travel_in-county.xls (30.5 KBs)
- Terminal Pay - Bencor - Bencor.pdf (325.6 KBs)
- Travel - Out of County (pdf) - travel_out-of-county.pdf (100.9 KBs)
- Travel - Out of County (excel) - travel_out-of-county.xls (33.0 KBs)
- W-9_blank - w-9_blank.pdf (116.5 KBs)