To apply for opt life, dependent life or disability insurance or to update beneficiaries - Group Benefit Change Form - EBEN 226
Support Units
Open Enrollment Forms
Below are the forms to use to enroll in any or all of the Extension benefits for 2019.
Health Plan Form
To enroll. add, drop, change, or terminate health coverage – EBEN-106
Health Savings Account Form
To enroll in the Health Savings Account - EBEN-110
Flexible Spending Accounts Form
To enroll in the Flexible Spending Accounts (FSA) – EBEN - 112
Dental Form
To enroll, add, drop, change, or terminate dental coverage – EBEN -105
Vision Plan Form
To enroll, change, or cancel vision coverage – EBEN -108
Voluntary Insurance Forms
Life and Disability Forms
To apply for opt & dependent life insurance - Standard Application
Federal Employee Health Benefit (FEHB)
To change health coverage – SF2809 Health Election Form
Catastrophic Leave Bank Program
To donate sick or annual leave – EBEN -103