Employee Resources

ENROLLMENT/CHANGE FORMS

• Medical Enrollment/Change Form
• Medical Opt-out Form (Declination of City-Sponsored Health Insurance)
• Dental Enrollment/Change/Opt-out Form
• Vision Enrollment/Change/Opt-out Form
• FSA Enrollment/Change/Opt-out Form
• AFLAC Cancellation Form
• AFLAC Enrollments/Changes will be made via phone. Please contact our plan representative, James Townes, directly at 562-951-5810.