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

UA Voluntary Insurance forms 

Life and Disability Forms

To apply for opt life, dependent life or disability insurance or to update beneficiaries - Group Benefit Change Form - EBEN 226

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