Open Enrollment Forms 2020
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DayForce Instructions
DayForce Open Enrollment Instructions
Forms
Note: Some of the below forms are PDF forms that can be completed online. When completing an online PDF form, please make sure to print the form after you complete it. You may also want to save the form to your computer desktop for your records.
First Reliance Standard Life Insurance Company (form can be completed online)
Health Savings Account (HSA) Account Information Form (this form cannot be completed online – you must print and then complete by hand) – Updated 11/12/19
Lake Shore Savings Bank HSA Enrollment Form (form can be completed online)
BPAS 403B Change of Beneficiary Form (form can be completed online)
Pharmacy Benefit Dimensions Mail-Order Pharmacy Form (this form cannot be completed online – you must print and then complete by hand)
2019 Open Enrollment Employee Worksheet (form can be completed online)
Informational Sheets
TRC Summary of Dental Benefits
New York State Disability/Paid Family Leave
Independent Health Find a Doctor
Independent Health Telemedicine Benefit
Independent Health Medical Help Line
Independent Health $0 Preventative Care Services