The COVID-19 Utility Municipal Relief Program can now provide more than one payment to utility customers with overdue utility bills that have experienced economic hardship due to the pandemic. Please contact Utility Billing Customer Service at 757-516-1001 for more information.
Forms
Health, Dental, Vision and Pharmacy
- 2020 - 2021 TLC Enrollment Form (USE FOR OPEN ENROLLMENT)
- 2019 -2020 TLC Enrollment Form (changes prior to July 1, 2020)
- 2020 - 2021 TLC Personal Data Change Form (effective July 1, 2020)
- 2019 - 2020 TLC Enrollment Form (changes prior to July 1, 2020)
- Prescription Drug Claim Form
- Home Delivery Order Form
Flexible Spending Account (FSA)
- FBA Benefits Card Election Form
- Employee Authorization for Payroll Deduction to Health Savings Account
- FBA FSA Enrollment Form
- FBA HSA Individual Enrollment Form
Life Insurance - Securian (Minnesota Life Website)
Voluntary Benefits
Virginia Retirement System (VRS)
- Application for Service Retirement (VRS-5)
- Certification of Hazardous Duty (VRS-77)
- Designation of Beneficiary (VRS-2)
- Designation of Beneficiary - Continuation (VRS-2A)