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DRBA
  • Eligibility
    • Eligibility
    • Qualifying Event
    • Eligible Dependents
    • Benefits Enrollment
      • New Hire
      • Open Enrollment
  • Health & Wellness
    • Medical
    • Health Savings Account
    • Prescriptions
      • Prescription Plan
      • COVID-19 Information
    • Telemedicine
    • Dental
    • Vision Plan and Hearing Discounts
    • Cost of Coverage / Opt-Out Incentives
    • Wellness Points
      & Incentive Programs
    • Disease & Condition
      Management Programs
  • Other Valuable Benefits
    • Flexible Spending Accounts (FSA)
    • Life and AD&D Insurance
    • Disability Insurance
    • Voluntary Benefits
      • MetLife Prepaid Legal Plan
      • Unum Short Term Disability & Other Voluntary Plans
      • Farmers Group Auto & Home Insurance
      • Pet Insurance offered by MetLife
      • Inside Rx Pets (Prescription Savings)
    • Employee Assistance Program
      & Core Advocacy Programs
    • Employee Perks
      • Credit Union
      • TickestatWork Discounts
      • SmartDollar
  • Retirement Plans
    • Hired On or After 01/01/2015
    • Hired Prior to 01/01/2015
    • Ready to Retire?
  • Resources & FAQ
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    • Forms Library
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Forms Library

Forms Library

This is a list of forms that are available for benefits mentioned on this benefits site. Click on the form name to open the form.

Certificate of Eligible Dependent Status Form

Delta Dental Claim Form

Express Scripts Claim Form

EyeMed Out-of-Network Claim Form

Highmark Claim Form

Opt-Out Incentive Election Form

Physician (Annual) Health Screening Form

Preventive Exam Form

Qualifying Life Event Benefits Enrollment Form

Unum Beneficiary Designation Form

Voya Beneficiary Designation Form

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Links and Documents

  • 2025 Benefits Overview Booklet
  • Contact Information
  • DRBA 401(a) and 457(b) Enrollment Instructions
  • 2025 Full-Time Employees Legal Notices
  • ESS Online Guide
  • Medical Plans: Summary of Benefits & Coverage (SBC)
  • Unum Beneficiary Updates
  • Voya Beneficiary Updates
  • Wellness Incentive Guide
  • What is COBRA?
  • What is FMLA?
  • What is HIPAA?
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Benefits Disclaimer

This Benefits Website provides general information for our benefit eligible employees; however, more detailed information is available within the plan documents and legal contracts between our company and the insurance providers. In case of any discrepancy between this Benefits Website and the plan documents, the plan documents always govern and determine your exact benefits. In addition, the company reserves the right to modify or terminate any benefit plan at any time. Benefits are not a guarantee of employment.

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