Benefits Forms
Health Related Forms
Extended Coverage Enrollment Form (COBRA)
Health Enrollment Form
Qualifying Event Notice
Anthem Claim Form
Flexible Spending Account Reimbursement Form
EZ Reimburse Card Information (new employees)
Please note: Completing an EZ Reimburse Card application does not enroll you in a Medical Flexible Account.
EZ Reimburse Card Application
More Health and Flexible Benefits Forms (DHRM)
Retirement Related Forms
Retirement and Life Insurance Forms (VRS)
Family and Medical Leave Act (FMLA) Forms
FMLA Leave Form
FMLA Certification Form
Return to Work Form
Virginia Sickness and Disability Program (VSDP) Forms
Extended Absence Leave Supplement Form
Return to Work Form
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