Enrollment Forms
Health Plan Enrollment
Health Plan Declination Form
Salary Redirection Agreement
Calstar Enrollment Form
Reach Enrollment Form
Please note:If you were enrolled in CalStar/Reach for 2012, they will automatically send you a renewal packet to complete for the next year's benefits.
Human Resources no longer process applications for CalStar/Reach. You will fill out the Enrollment form and send it directly to CalStar and Reach individually.
Claim Forms
Medical Claim Form after April 1, 2013
Medical Claim Form prior to April 2013
Dental Claim Form
Vision Claim Form
Prescription Drug Reimbursement Form
Flexible Spending Claim Form
Express Scripts Forms
Medco by Mail- Mail in Prescription Order Form
Medco by Mail- Fax in Prescription Order Form
— Free software is required to read PDFs.