Employer Information Resources
Policies, Documents, and Forms
Administrative Guide
Administrative Letters
Agency Refund Request Form
Benefits Eligibility Acknowledgement Form (English)
Benefits Eligibility Acknowledgement Form (Español)
COBRA Notification to Term Benefits
Death Claim Form
DFA Summary Page (Download)
Disability Policy
Disability Calculation Sheet (Download)
Domestic Partnership Form
Employee Enrollment Resources
Employee Refund Request Form
LWOP Benefit Premium Transmittal Form
POLICY: Leave Without Pay (LWOP), Longevity Pay, and Premium Responsibilities
Notification to Terminate Benefits Due to Non-Payment of Premiums
POP Waiver Form (State)
Premium Rate Sheets – State
Refund Request Form
W9 Blank Form (Benefits Refund)
W9 Blank Form (Other)
Notices, Resources, Information
Benefits Comparison Guide 2025
Benefits Comparison Guide 2024
Benefits Information
Benefit Plan Contacts
Benefits Premium Calculator
COBRA Resources
Disability Resources
Federal Medicare Part D Creditable Coverage Notices
HIPAA Privacy Notice
HR Meetings and Recordings
SHARE Self Service Instruction Guide
Trifold Benefits Brochure
How to Submit Current Calendar and Prior Fiscal Year Refund Requests
Machine Readable Formats (MFR)
Local Public Body (LPB) Forms
LPB Employee Change/Correction Form
POP Waiver Form (LPB)
Premium Rate Sheets – LPB