Forms

EPISD Employee Benefits

• Change of Beneficiary Form

TRS-ActiveCare Health Plan

• Enrollment Form
• Section 125 election Form
• Split Premium
• Transitional Benefits
• Statement of Disability
• BCBS Claim Form
• General Notice
• HIPAA Authorization Form
• Privacy Notice
• TRS-AC Declination Certification

EPISD Health Resource Center

• Patient Registration Form
• Health Clinic Schedule
• On-site Immunizations

Health Savings Account Categories

• HSA Enrollment/Change Form

ING Life Insurance Forms

• W-9 ING Form
• ING Death Benefits Claim Form
• Evidence of Insurability Form 2012-13
• Evidence of Insurability Form 2012-13 Instructions

Leave Management Forms

• Employees Rights and Responsibility
• FMLA Rights & Responsibilities
• FMLA Rights & Responsibilities-Spanish
• Leave Comparison Chart
• Family Medical Leave (FMLA) Request Form
• Certification of Health Care Provider
• Certification of Health Care Provider for Family Member
• 2012 Catastrophic Sick Leave Bank (CSLB) Enrollment Form
• CSLB Request Form

UNUM Disability Forms

• Disability Claim Form
• Medical Treatment Claim Form