Health Insurance Forms and Publications
	Election Forms to Make Changes Health Insurance Election Form (active employees) Health Insurance Election Form (retirees) Spouse Program Election Form State Employees' PPO Plan Plan Booklet and Benefits Document Effective January 1, 2012 (coming soon) PPO Plan Brochure RxBenefits at a Glance (Standard Plan) RxBenefits at a Glance (Health Investor Plan) Maintenance Drug List Preferred Drug List Non-Network Medical Claim Form Non-Network Prescription Claim Form Prescription Drug Reimbursement Form Prescription Mail Order Form RxBenefits Brochure - Being Prepared for an Emergency HMO Plan Documents (coming soon) Aetna Standard Health Care Plan Aetna Health Care Investor Plan AvMed Standard Health Plan AvMed Health Investor Plan Capital Health Standard Plan Capital Health Investor Plan Coventry Health Care of Florida Standard Health Plan Coventry Health Care of Florida Health Investor Health Plan Florida Health Care Standard Plan Florida Health Care Investor Plan United Healthcare Standard Plan United Healthcare Investor Plan

Basic and Optional Life Insurance Forms and Publications
	Forms Group Life Insurance Enrollment Form (active employees) Conversion of Group Life Insurance Enrollment Form (active employees) Life Insurance Portability Election Form (active employees) Group Life Insurance Evidence of Insurability Beneficiary Designation and Change Request Form Publications Minnesota Life Term Life Insurance Brochure Employee Group Term Life Certificate of Insurance Retiree Group Term Life Certificate of Insurance Take Advantage of Your Group Life Insurance Benefits (active employees) Changes In Your Coverage When You Retire (retirees)

Supplemental Insurance Forms and Publications
	Dental - Active Employees and COBRA Participants Only Dental Insurance Election Form CompBenefits Prepaid (Network Plus)/PPO Preferred Plus Dental Plan Brochure PeopleFirst Plan Code 4004 & 4044 UnitedHealthCare Prepaid (Solstice S700) Dental Plan Brochure PeopleFirst Plan Code 4014 Assurant Prepaid (Heritage Plus)/Indemnity with PPO (Freedom Advance) Dental Plan Brochure PeopleFirst Plan Code 4024 & 4074 CIGNA Prepaid Dental Plan Brochure People First Plan Code 4034 CompBenefits Prepaid (Select 15)/Indemnity (Schedule B)Dental Plan Brochure PeopleFirst Plan Code 4044 & 4084 Ameritas Indemnity with PPO Dental Plan Brochure PeopleFirst Plan Code 4064 Vision - Active Employees and COBRA Participants Only Vision Insurance Election Form Humana Vision Plan Brochure Other Supplemental Plans - Active Employees Only Accident Insurance Election Form Cancer Insurance Election Form Disability Insurance Election Form Hospital Intensive Care Insurance Election Form Hospitalization Insurance Election Form Aflac Cancer/Hospital Intensive Care Insurance Plan Brochure CHLIC (formerly Alta) Supplemental Hospital Plans Brochure Colonial Accident/Cancer/Disability Insurance Plan Brochure New Era Hospital Income Plan Brochure

Flexible Spending Accounts and Health Savings Account Forms and Publications
	Active Employees Flexible Spending Account Claim Form Tax-Favored Accounts Comparison Chart Tax-Favored Account Election Form Tax-Favored Accounts Reference Guide MRA Options When Employment Ends Letter of Medical Need for Medical Reimbursement Account Personal Use Statement Capital Expenditure Worksheet HSA Tallahassee State Bank Application How to Enroll in an HSA (HIHP Plan members only) myMRA Card for the 2012 Plan Year (MRA and LPMRA members only)

Other Forms and Publications
	Forms Authorization to Use and/or Disclose Personal Health Information Form Pretax Premium Waiver Form Publications Employee and Retiree Benefits Guide State Group Insurance Benefits Package for New Retirees Options to Continue Insurance Benefits for Career Service Employees Special Notice About Medicare Part D State Group Insurance Privacy Notice SMS and SES Disability Income Plan Qualifying Status Change Event Matrix Helpful Terms Required Documentation Are My Dependents Eligible?