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Forms

Home/Resources/Forms
FormsEBAdmin2019-04-01T20:58:10+00:00

Here you’ll find the forms you need to manage your benefits. Download the forms by clicking on the links. You can also request a hard copy of any form by contacting the Benefits Service Center.

Medical Forms
Collective Health Disability Statement for Overage Dependents PDF
Dental Forms
Delta Dental PPO Claim Form PDF
Cigna Dental PPO Claim Form PDF
Life, Disability & Voluntary Benefit Forms
Unum Long Term Disability EOI Form PDF
Unum Long Term Disability EOI Form Spanish PDF
Unum STD Claim Form PDF
Unum LTD Claim Form PDF
Unum Supplemental Life EOI Form (001 Dept Heads, Service Center Employees) PDF
Unum Supplemental Life EOI Form (002 Nurses, Therapists) PDF
Unum Supplemental Life EOI Form (003 All Other Eligible Employees) PDF
Unum Accident Insurance Claim Form PDF
Unum Critical Illness Claim Form PDF
Unum Hospital Indemnity Claim Form PDF
Other Forms
Emergency Fund Voluntary Donation Authorization PDF

Resources

  • Ensign Benefits Center
  • Mobile Apps
  • Contacts
  • Forms
  • FAQs
  • Healthy Living Resources
  • Guides, Summaries and Flyers
  • Legal Notices
  • Video Library
  • Admin Login
  • Open Enrollment

Benefit Basics

  • Benefits Directory
  • Eligibility
  • Open Enrollment
  • New Hire Enrollment
  • Life Changes
  • Ask ALEX
  • Health Care Reform

Health & Wellness

  • Medical
  • Prescription Drug Benefits
  • Health Savings Account
  • Collective Health
  • Telemedicine Through Teladoc
  • Grand Rounds
  • Dental
  • Vision

Financial Protection

  • Flexible Spending Accounts
  • Transportation Benefit Program
  • Life and AD&D Insurance
  • Disability
  • Voluntary Group Accident
  • Voluntary Critical Illness
  • Voluntary Hospital Indemnity
  • Auto & Home

Time Off

  • Paid Time Off
  • Leaves of Absence

Retirement

  • 401(k) Savings Plan

Work-Life

  • Employee Assistance Program
  • Tuition Reimbursement
  • Child Care Benefit Program
  • TicketsatWork
  • Purchasing Power
  • Intalere Marketplace
  • The Emergency Fund

Resources

  • Ensign Benefits Center
  • Mobile Apps
  • Contacts
  • Forms
  • FAQs
  • Healthy Living Resources
  • Guides, Summaries and Flyers
  • Legal Notices
  • Video Library
  • Admin Login
  • Open Enrollment
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