Benefits Forms 

These forms may be needed when you sign up for benefits as a new hire or if you need to make changes as an existing employee. 

Benefit Change Form - Used to make changes to the dependents enrolled on your plans, such as, adding new child or spouse.

Affidavit for Domestic Partnership - Required if enrolling a domestic partner as a dependent on your plans.

AFLAC reimbursement forms -

• Flex One - FSA - Medical
• Flex One - FSA - Medical and Daycare
• Transit One - Parking or Mass Transit

Nationwide (NACO) Deduction Change Form - Use this form to make changes to the amounts deducted for deferred compensation.

Waiver of Pre-tax Medical Premium Contribution - Medical Premiums are automatically pre-taxed.  If you don't want them pre-taxed, submit this form.

Waiver of Health Care Coverage

Retirement Beneficiary Form

Cancellation of Voluntary Deductions

LifeWise Beneficiary Change form

Regence Claim Form

Hardship Withdrawal Form (deferred compensation)

Enrollment Forms

These forms may be needed when you sign up for benefits as a new hire or if you change plans during open enrollment.  Other forms are available in Human Resources.

Regence Enrollment Form

Group Health Enrollment Form

Willamette Dental Enrollment Form

Delta Dental (WDS) Enrollment Form

Cigna Dental Enrollment Form

LifeWise Enrollment Form

LifeWise Optional Insurance Form

Back to New Employee Home Page
(Getting Started)

Return forms to Human Resources at Mail Stop 503
human.resources@snoco.org
(425) 388-3411