Employee Benefit Forms

Once you have decided on your benefit choices, print all of the appropriate forms listed in the box to the right. Submit all completed forms—and a signed copy of your Enrollment Checklist to your direct employer.

Note: If you do not want to enroll for health coverage, sign the waiver section of the enrollment form.

The choice you make when you enroll generally remains in effect until the next annual open enrollment (usually held in May). However, you may change your benefit elections during the year if you have a qualifying change in status, or if you or a qualified dependent loses other employer-sponsored group coverage.

Changes to optional life insurance can be made at any time, but may require additional information about your or your family member’s health. You can make changes to your 403(b) Savings Plan at any time.

Forms you will need for enrollment (new hire or midyear, if eligible):

Print ID cards (your medical and prescription cards will be mailed to your home address):

Complete a Life Insurance beneficiary form at any time.

Credit Union application can be found at Atlantic Federal Credit Union web site.

MD First Report of Injury Claim Form – needed to report Workers compensation claims.