Employee Benefits
2013 Benefits
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Forms
Forms for 2013
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SPC > HR > Employee Benefits > HR Forms

HR Forms

Medical

Prescription
Aetna Prescription Home Delivery Order Form and Information
Dental
Aetna Dental Claim Form
Aetna Medical and Dental Enrollment Form
Life
Aetna Life Insurance Designation of Beneficiary Form
Aetna Life Insurance Enrollment Form
Aetna Life Insurance Guide to Adding Spouses and Dependents
Disability
Lincoln Financial Group Disability Insurance Enrollment Form
Lincoln Long-term Disability Claim Form
Lincoln Short-term Disability Claim Form
Vision
Advantica Vision Insurance Enrollment Form
HSA
Request to Close Health Savings Account
Request to Transfer Funds from Health Savings Account at Chase
FSA
FSA web page

Fact Sheet

Online FSA account

How to file a claim

FSA Direct Deposit Form

Member Services: 1-800-809-8161
Fax: 352-369-9461
Cancer
Allstate Wellness Claim Form
MERP (Medical Expense Reimbursement Plan)
MERP Claim Form (Physician)
MERP Itemized Expenses Form and Directions
Vision Reimbursement
Vision Expense Reimbursement Form
Hospital
Hospital Indemnity Insurance Claim Form
Hospital Indemnity Insurance Enrollment Form
HIPAA
HIPAA Complaint Form
HIPAA Release Authorization (Aetna)
HIPAA Release Authorization (SPC)
Leave Donation
Leave Donation Form
Request Use Of Donated Leave Form