Open Enrollment Forms 2024

Updated September 15, 2023

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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)

Lake Shore Savings Bank HSA Brochure

Lake Shore Savings Bank HSA Enrollment Form

AIG Beneficiary Designation Form

Informational Sheets

Pro-Flex FSA Expenses

TRC Full Plan Comparison Page

TRC Summary of Dental Benefits

VSP Vision Care Benefits

VSP Vision Care Doctor List

VSP Vision Care Provider List

Independent Health MyIH App

Independent Health Find a Doctor

Independent Health Telemedicine Benefit

Independent Health Medical Help Line

Independent Health $0 Preventative Care Services

TRC Prescription Benefits

Pharmacy Benefit Dimensions Mail Order

403b Summary Plan Description

Vendor Contact List