Benefits
DC 37 Health & Security Plan Benefits
DC 37 Health & Security Plan Forms
All forms below are available in PDF format. Each form includes instructions.
- H&S Enrollment Form
- Change of Status Form
- Prescription Prior Authorization Form
- Death Benefit Application Form
- Beneficiary Form
- Death Benefit Affidavit Form
- ADA Dental Form
- Dental Providers
- Optical Reimbursement Form
- Optical Providers
- Annuity Benefit Application Form
- Annuity Benefit Beneficiary Designation Application Form
- Annuity Benefit Rollover Application Form
- Disability Claim Form
- COBRA
