Forms and Important Information

2027 RATE SHEETS

PRE-55 RATE SHEET: For those retirees under the age of 55

55+ RATE SHEET: For those retirees 55 years and older that retire after July 31, 2021

ENHANCED RATE SHEET: For Public Safety employees that are on an enhanced plan (police, fire, corrections, judges)

PRE-RULE CHANGE RATE SHEET: For those that retired before July 31, 2021

2027 SUMMARY OF BENEFITS BOOKLETS

2027 Summary of Benefits Booklet

2027 Medicare Summary of Benefits Booklet

2026 RATE SHEETS

PRE-55 RATE SHEET: For those retirees under the age of 55

55+ RATE SHEET: For those retirees 55 years and older that retire after July 31, 2021

ENHANCED RATE SHEET: For Public Safety employees that are on an enhanced plan (police, fire, corrections, judges)

PRE-RULE CHANGE RATE SHEET: For those that retired before July 31, 2021

2026 SUMMARY OF BENEFITS BOOKLETS

2026 SUMMARY OF BENEFITS BOOKLET

2026 MEDICARE SUMMARY OF BENEFITS BOOKLET

FREQUENTLY REQUESTED FORMS

GENERAL ENROLLMENT PACKET

CHANGE REQUEST FORM

SWITCH ENROLLMENT FORM

MEDICARE SWITCH ENROLLMENT FORM

LIFE INSURANCE BENEFICIARY FORM

LIFE INSURANCE MEDICAL HISTORY STATEMENT

DOMESTIC PARTNER PACKET

ACH AUTHORIZATION FORM

Archive

2025 SUMMARY OF BENEFITS BOOKLET

2025 MEDICARE SUMMARY OF BENEFITS BOOKLET

2025 Rates Sheets

2024 Rates Sheets Prior to July 1, 2024

2023 SUMMARY OF BENEFITS BOOKLET

2023 MEDICARE SUMMARY OF BENEFITS BOOKLET

2023 PRE-55 RATE SHEET: For those retirees under the age of 55

2023 55+ RATE SHEET: For those retirees 55 years and older that retire after July 31, 2021

2023 ENHANCED RATE SHEET: For Public Safety employees that are on an enhanced plan (police, fire, corrections, judges)

2023 PRE-RULE CHANGE RATE SHEET: For those that retired before July 31, 2021

2022 General Enrollment Packet
2022 Summary of Benefits Booklet
2022 Medicare Summary of Benefits Booklet
2022 Pre-55 Rate Sheet
2022 55+ Rate Sheet
2022 Enhanced Retired Rate Sheet
2022 Rate Sheet for Retirement Prior to July 31, 2021
2021 Summary of Benefits Booklet
2021 Medicare Summary of Benefits Booklet
2020 Summary of Benefits Booklet
2019 Summary of Benefits Booklet
2018 Summary of Benefits Booklet
2017 Summary of Benefits Booklet