• Electronic Funds Transfer (EFT)
  • EFT is a payment method that allows you to have your payment automatically deducted from your checking or savings account.

• Proof of disability
  • MD should state when disability started and when employee can return to work.
  • Return form to Your Insurance Company. Address is on form.
• COBRA Form
  • 60 days from date of qualifying event to apply. Additional info call Customer Service 1-800-842-9905.
• Retirement Application
  • Send application 30 days prior to retirement date to address on form.
  • Questions regarding retirement, call 1-800-842-9905.
• Supplemental Insurance
  • Supplemental plans A, B, C, E or F must be applied for within 4 months of eligibility.
  • If you do not apply within the first 4 months, you must wait for open enrollment which occurs each December of even years.
• Beneficiary Affadavit
  • Form for families to designate a beneficiary of a deceased member.
• Provider Nomination
  • If your physician is interested in becoming a UnitedHealthcare Provider, please give him or her this information.

• MetLife Beneficiary Designation Forms and Instructions
  • MetLife Beneficiary Designation Form and Instructions for 23000
  • MetLife Beneficiary Designation Form and Instructions for 690100
  • MetLife Beneficiary Designation Form and Instructions for 107300
  • If you need to update your life insurance beneficiary designations with Met Life, use one of the above forms and instructions.

• Michelle's Law
  • Student Medical Leave Certification Form Instructions.