Enrollment Forms

The following are required to complete for NEW HIRES through Employee Navigator:

• Life Insurance Beneficiary

• BlueCross/BlueShield Health, Dental, and Vision election

• Optional Life Insurance Enrollment/Change

• Flexible Spending / Dependent Care election

The following form is required to complete for ALL STAFF ONLY IF ADDING A DOMESTIC PARTNER TO YOUR INSURANCE PLAN:

• Domestic Partner Affidavit and 3 additional documents listed

To print the affidavit, click on the pop-out box in the upper right hand corner of the desired form, then print from your browser. Please return to Jessica Lerner in the Human Resources Office (H113) on or before November 22, 2024.