Active Benefits Application Health, Dental, Basic Life (Eff 1/1/24)

Active Benefits Application Health, Dental, Basic Life (Eff 1/1/25)

Voluntary Benefits Application (Vision & Disability) Updated 12/2023)

Voluntary Life Application ( 2021)

MASA Ambulance Application  (updated 7.2022)

2024 Flexible Benefit Election Form 

2025 Flexible Benefit Election Form

Flex Benefits Change Form (used for mid year changes)

Health Savings Account Election Form (updated 09.2024)

Basic Life "underwriting" Application Link