Forms
Health, Dental, Vision and Pharmacy
- 2022 - 2023 TLC Enrollment Form
- 2022 - 2023 TLC Personal Data Change Form
- Prescription Drug Claim Form
- Prescription Home Delivery Order Form - English
- Prescription Home Delivery Order Form - Spanish
Flexible Spending Account (FSA)
- Address change form
- Account maintenance form
- Benefits card election form
- Direct deposit form
- FSA Enrollment form
- FSA Dependent care reimbursement form
- FSA Medical reimbursement claim form
- Limited FSA medical reimbursement claim form
- Status change form
Health Savings Account (HSA)
- HSA Enrollment Form
- HSA Payroll Deduction Form
- HSA Name Change Request Form
- HSA Benefits Card Election Form