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

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

Voluntary Life Application ( 2021)

MASA Ambulance Application  (updated 7.2022)

2024 Flexible Benefit Election Form 

Flex Benefits Change Form (used for mid year changes)

Health Savings Account Election Form (updated 7/2023)

Basic Life "underwriting" Application Link