For your convenience, all benefit forms are now available online. Each form comes in an easy to read and use pdf format.

The forms maybe completed in one of two ways:

  1. Print the form and complete by hand, OR;
  2. Complete the form on your computer, then print and sign.

Send completed forms via interoffice mail, postal service, or in person, to the County’s benefits staff representative listed in the Contact information of this website. FORMS MAY NOT BE ELECTRONICALLY TRANSMITTED

Vision Insurance


Summary of Vision Benefits

Download Benefits Summary

Enrollment Form

Humana Benefits Enrollment Form

Download Enrollment Form

Change Form

Humana Benefits Change Form

Download Change Form


Humana Vision Cancellation Form

Download Form