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Home / Employee Benefits & Wellness/Enrollment and Eligibility Requirements

Enrollment and Eligibility Requirements

Benefit Forms and Notices

  • Definitions and Required Documents
  • Dependent Eligibility Beyond Limiting Age
  • Medicare Request Form
  • Statement of Dependent Eligibility Beyond Limiting Age Due to Mental or Physical Disability Form
  • Transfers, Rehire, Newly Eligible Employees - Management Use Only
  • Uniform Glossary of Terms

ThriveOn Forms and Notices

  • Biometric Screening Form (for WorkHealth and PCP)
  • 2025 Proof of Exam Form  (for annual physicals, preventive screenings, vision/dental exams, etc.)
  • Notice of Employer Sponsored Wellness Program

Bariatric Services

  • Bariatric Surgery FAQ
  • Bariatric Resource Services (BRS)

Domestic Partnership

  • Domestic Partner FAQ
  • Domestic Partner Affidavit
  • Affidavit of Termination of Domestic Partnership
  • 2026 Monthly Health Plan Contributions

Submit An Appeal

Reduced Deductible Appeal

The Reduced Deductible Incentive is earned by completing both the Online Health Assessment and Annual Physical. If you feel that you have been place in the wrong deductible plan please complete the Reduced Deductible Appeal form.

Submit A Benefit Appeal

Please complete the form below if you have an appeal related to your benefits (not including a Reduced Deductible). Provide complete information and attach any supporting documentation that can assist in making a determination.


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