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Forms
Below are all the forms related to the health and wellness programs offered. Click on the form you require and either save or print. If you have any questions, please contact your benefits representative.
• Affidavit - Dependent Age 26-30 (Non-disabled)
• Affidavit - Spouse Surcharge
• Authorization for Release of Health Information
• Instructions to Change Your Beneficiary
• Benefits Change Form (2018)
• Proof of Handicapped Disability
Biometric and Health Risk Assessment Forms
If you are a new hire, or you are making a status change, use the following documents:
• New Hire Biometrics Lab Voucher
• Wellness Activity/Biometric Form
• Cigna Wellness Screening Form
If you did not select the BPS Health Plan for 2017, and you are selecting the BPS Health Plan for 2018 or currently have the BPS Health Plan and will be enrolling again in 2018 but did not complete the biometric screening conducted at your site or have the opportunity to visit your doctor, use the following documents:
• Open Enrollment Lab Voucher
• Wellness Activity/Biometric Form
• Cigna Wellness Screening Form
Important Forms
34 | BPS Employee Benefits Guide
RESOURCES