Benefits Information


Forms

AD&D

Change in Family Status


Deferred Compensation

Flexible Spending Account

  • FSA Reimbursements for Claims Only
  • pdf icon 2014 FSA Reimbursement Form
    Form used to submit reimbursement request for eligible health and dependent care expenses.
  • word document icon FSA Change Form
    Make allowable changes to current address, status or contributions for health and/or dependent care.
  • pdf icon Benefits Card/Direct Deposit Request Form
    Form to authorize reimbursements to be deposited directly into your bank account and/or request for pre-paid Benny Card to pay for qualified health care expenses up front.

Life Insurance

Long Term Disability Insurance

For the LTD claims packet, please contact your department's benefits representative.

Medical & Health Care

Military

Open Enrollment
Privacy Policy

Publications


Page: http://www.seattle.gov/personnel/benefits/library/forms.asp
Printed: 9/18/2014 6:39AM