Open Enrollment Forms 2022

Updated October 13, 2022

You must have a PDF reader to open and complete these files online. The download Adobe Reader, please click the icon below.

DayForce Instructions

DayForce Open Enrollment Instructions

Forms: Please completely fill out these forms and do not skip any highlighted areas.

First Reliance Standard Life Insurance Company (Evidence of Insurability Form)

Health Savings Account (HSA) Account Information Form

Lake Shore Savings Bank HSA Enrollment Form

BPAS 403B Change of Beneficiary Form

Informational Sheets

TRC – Green Plan OE Presentation Final

TRC – HSA Plan OE Presentation Final

TRC – Non HSA Plan OE Presentation Final

Pro-Flex FSA Expenses

Health Plan Comparison

TRC Full Plan Comparison Page

TRC Summary of Dental Benefits

EyeMed Vision Care Benefits

New York State Disability/Paid Family Leave

Independent Health MyIH App

Independent Health Find a Doctor

Independent Health Telemedicine Benefit

Independent Health Medical Help Line

Independent Health $0 Preventative Care Services

RX Benefits

TRC Prescription Benefits

Vendor Contact List 2021