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APS Claims Submission Form
Medicare Part D Notice of Creditable Coverage (Plan Year 2012)
Disabled Dependent Certification Form
Met Life AD & D Plan Beneficiary Designation Form
HEARTS FSA Distribution Request
Met Life Life Insurance Beneficiary Designation Form
HIPAA Authorization Form
Met Life Statement of Health Form
HIPAA Certificate of Coverage
Non-Payment of Benefit Deduction Letter
IRS Worksheet to Determine Dependent Support
Personal Information Change
Mail Order Prescription Brochure and Form
State Notification of Medicare Information
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Birth, Marriage, Death Certificates
Enrollment Forms -
July 1, 2011 - June 30, 2012
Active/Satellite Employees
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Direct Pay Instructions
Retiree
Dependent Affidavits
July 1, 2011 - June 30, 2012
Dependent Child Documentation Checklist
Dependent Child Tax Affidavit
Domestic Partner Affidavit
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Domestic Partner Affidavit Notary Form
Domestic Partner's Dependent Child Tax Affidavit
Domestic Partner's Dependent Child Documentation Checklist
Dissolution of Domestic Partnership Affidavit
Spousal Eligibility & Tax Status Affidavit