Indian River County Florida
 
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Benefits - Forms and Links
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* Note: Items marked with (ESS) are completed on the Employee Self Service Website

Medical Benefit Flex Benefit
Medical Plan Enrollment •  Flexible Spending Account Enrollment
Medical Plan Change • Advantages of Flexible Spending Account (FSA)
• Florida Blue Website: FloridaBlue.com • Flex Benefit Website: tasconline.com
BlueOptions Schedule of Benefits  
BlueOptions Benefits Booklet Vision Benefit
  •  Vision Plan Enrollment
  •  Vision Plan Summary of Benefits
Voluntary Term Life Insurance / Disability • Vision Plan Website: eyemedvisioncare.com
•  Designation of Beneficiary  
•  Term Life & LTD Enrollment Benefit Miscellaneous
•  Voluntary Term Life Benefit Summary • Aflac Accident Wellness Claim Form
• 90 day Benefit Summary • Aflac Cancer Screening Wellness Claim Form
• 180 day Benefit Summary  
• Term Life & LTD Evidence of Insurability Hardcopy Florida Retirement System (FRS)
• Term Life & LTD Evidence of Insurability Online Version • Beneficiary Designation Pension Plan
• Mutual of Omaha Website • Beneficiary Designation Investment Plan
  • Florida Retirement System website: MyFRS.com
Dental Benefit  
• Dental Plan Enrollment HIPPA
• Dental Plan Summary of Benefits • HIPAA Notice of Privacy Practices
• Certificate of Dental Insurance (Low Plan)  
• Certificate of Dental Insurance (High Plan) Annual Notices
• Ameritas Dental Policy • 2017/2018 Summary of Benefits & Coverage
• Ameritas Website: www.ameritas.com • Notice of Special Enrollment Rights
  • Women’s Health and Cancer Rights
  • Children’s Health Insurance Program (CHIP)
   
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