UACES Facebook Open Enrollment Forms
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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

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

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