Division of General Services

Policies and Procedures

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Forms - HEALTH

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Native Traditional Healing Procedures
Native Traditional Healing Benefit Form
WellDyneRx Member Registration
WellDyneRx Preferred Drug List
WellDyneRx Mail Order Prescription Delivery Service Registration
WellDyneRx Reimbursement Claim Form

 

Forms - LIFE

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MetLife Grief Counseling Flier
MetLife Plan Summary
MetLife Beneficiary Designation Form
Addendum - Primary Beneficiary
Addendum - Contingent Beneficiary
MetLife Claim Form
MetLife Accidental Death & Dismemberment Claim Form
MetLife Accelerated Benefit Option Form
MetLife Optional Term Life Plan Summary
MetLife Optional Term Life Application
MetLife Statement of Health Form

 

Forms - SHORT-TERM DISABILITY

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Short-Term Disability Instructions
Short-Term Disability Sick leave Form
Short-Term Disability Preliminary Statement of Disability
Short-Term Disability Attending Physician Statement

Policies and Procedures

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Forms

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Policies and Procedures

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Forms

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Report of Injury
Traditional Healing Expense(s) Claim Form
Travel Expense Report
Medical Waiver Statement Form
Consent to develop Medical & Wage Information