BENEFITS FORMS

To enroll in benefits or change your benefits:

• ​BCPS Enrollment/Change Form 
  New hires must submit form within 60 days of your hire date.  Current employees must submit changes within 30 days of a qualifying event.  All other changes must be submitted during the annual Open Enrollment period.

Medical:

• Cigna Medical Claim Form
• Cigna Transition of Care/Continuity of Care with Mental Health Form

Prescription:

• Cigna Prescription Drug Claim Guide Sheet (under 65) (Instructions for completing the drug claim form)
• Cigna Prescription Drug Claim Form (under 65)

Dental:

• CareFirst Dental Claim Form

Vision:

• CareFirst Davis Vision Reimbursement Claim Form

Flexible Spending Account:

• Benefit Strategies FSA Enrollment (new enrollments only)
  • To enroll in a FSA plan during Open Enrollment  (either health care or dependent care) please visit the Benefit Strategies Portal. Employees must use their Employee ID found on the home screen of ESS, under General Information.  Social security numbers may not be used for enrollment in a FSA health care or dependent care account. For troubleshooting assistance, please call 1-888-401-3539.
• FSA Overview
• FSA Health Care Eligible Expenses
• FSA Dependent Care Eligible Expenses
• FSA Tax Savings Calculator

Life Insurance and PAI (Personal Accident Insurance)

• MetLife Employee Enrollment/Change Form
• MetLife Statement of Health
• MetLife Beneficiary Designation