Human Resources Forms

2018-2019 Benefits

• Blue Shield Trio HMO
• Beneficiary Designation/Change Card
• Benefit Enrollment Form and Rates
• Blue Shield Access Plus HMO
• Blue Shield Pharmacy Form
• Blue Shield PPO
• Delta Dental - PPO Plan Summary
• DeltaCare USA - Plan Summary
• Enrollment Guide
• EyeMed - Plan Summary
• Health Advocate EAP
• Kaiser - $20 Plan Summary
• Kaiser - $40 Plan Summary
• Vol. AD&D Brochure
• Vol. Life Insurance

American Fidelity

• American Fidelity - Accident Plan
• American Fidelity - Brochure
• American Fidelity - Cancer Plan
• American Fidelity - Disability Plan

Leave of Absence Information

• Employee Leave of Absence Instructions
• Family Care - CSEA
• Family Care - CTA
• Leave of Absence Request Form
• Medical Disability - CSEA
• Pregnancy - CSEA
• Pregnancy - CTA

Workers Compensation - Employee

• Covered Employee Notification
• Instructions for Injured Worker

Workers Compensation - Providers

• FOX Occupational
• LOMA LINDA UNIVERSITY

Workers Compensation - Supervisor

• DWC-1
• Employee Statement
• Medical Authorization
• Supervisor Instructions
• Supervisor Statement
• Witness Statements