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


Humana

Summary of Vision Benefits

Download Form

Enrollment Form

Humana Benefits Enrollment Form

Download Form

Change Form

Humana Benefits Change Form

Download Form

Waiver Form

Humana Vision Care Waiver Form

Download Form

Cancellation

Humana Vision Cancellation Form

Download Form