Forms
Health and Welfare Benefits Forms
- Blue Cross Member Claim Form/ Medical Plan
- CVS Caremark Prescription Reimbursement Claim Form/ RX
- VSP Claim Form / Vision
- Vision Perfect Claim Form / Vision
- Unreimbursed Medical Claim Form / Flexible Spending Account
- Dependent Care Claim Form / Flexible Spending Account
- Evidence of Insurability Form / Life Insurance
- NCPERS - Enrollment Form / Life Insurance
Retirement Forms
- Optional Retirement Plan Enrollment Form
- Supplemental Retirement Salary Reduction Authorization
- RS115 - Beneficiary Designation / PERSI
- RS108 - Request for Base Plan Account Withdrawal with Special Tax Notice / PERSI
Leave Forms
- Application for Family Medical Leave
- WH-380-E - Certification of Health Care Provider for Employee's Serious Health Condition
- WH-380-F - Certification of Health Care Provider for Family Member's Serious Health Condition
- WH-384 - Certification of Qualifying Exigency For Military Family Leave
- WH-385 - Certification for Serious Injury or Illness of Covered Servicemember
- Shared Leave Application
- Shared Leave Donation Form
Education Benefit Forms
- Registration Permit - Employee
- Registration Permit - Spouse
- Reciprocal Education Agreement - Employee
- Reciprocal Education Agreement - Spouse
Other Forms
- Adoption Assistance Application
- Tobacco Cessation Reimbursement/Override
- Prepaid Legal Enrollment Form
- Pre-Authorized Checking Registration Form (Retirees Only)
Summary Plan Description- Active Plan
Summary Plan Description- Retiree Plan