Health and Benefits Forms

Health Forms for use during Open Enrollment

Selection of Health Insurance You must submit this to Danielle Leonard within 10 days of being hired

Boston Mutual Life Insurance (OPTIONAL) If you choose to decline life insurance, you still need to sign the refusal section.

Dental Insurance with Altus Dental (OPTIONAL) This form is optional. Submit only if you choose to pay for dental insurance.

Vision Insurance with Eye Med Enrollment and Change Form (OPTIONAL) This form is optional. Submit only to enroll in eye insurance.

Ameriflex Flexible Spending (OPTIONAL) This is an optional pre-tax benefit that can be spent on medical needs.