Risk and Benefits Management

831 Simpson Rd. STE 100; Kissimmee, FL 34744

Phone: 407-870-4899 / Fax: 407-943-7749

Rick Hensley ARM, SPHR

Director of Risk and Benefits Management

Forms

The forms on this page require Adobe Acrobat Reader.  You may download the reader at:  http://get.adobe.com/reader/

Center for Employee Health
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AdventHealth transfer of medical records to RosenCare Request Form

Tax Sheltered Annuities Forms

  1. Salary Reduction Agreement 403(b)
  2. Salary Reduction Agreement 457(b)
  3. Salary Reduction Agreement Roth 403(b)
  4. Transaction Processing Instructions
  5. Transaction Routing Request Form
  6. Osceola Disclosure Form
  7. Hardship Withdrawal Disclosure
  8. 457(b) Unforeseen Financial Emergency Disclosure

Cigna Medical Insurance Forms

  1. Health FSA Reimbursement Request Form
  2. Dependent Care FSA Reimbursement Request Form
  3. Dependent Care FSA form changes document

Humana Dental Effective 10/01/2019

  1. Humana Benefits Booklet

Delta Dental Insurance Forms (10/1/2016-09/30/2019)

  1. Ortho Takeover Form
  2. PPO Claim Form

EyeMed- Effective 10/1/2017
      1. EyeMed Out of Network Claim Form


MetLife Life Insurance

1.  Term Life Insurance Beneficiary Change Form
     

Aetna Disability Forms (claims beginning 10/01/2013)

  1. Medical Treatment Claim Form
  2. To file a disability claim,  follow the instructions here.

Lincoln Financial Group Disability Forms -Effective 10/1/2017
      1.  OSCEOLACTY- STD One Call Claims Brochure.pdf
      2.  Disability Claim Form


Trustmark Forms - New 2017 Rates Effective 10/1/2017
     Click Here Trustmark Accident Ins 17-18.pdf

  1. Trustmark Universal Life/Death Claim Form
  2. Trustmark Universal Lifelong Term Care Claim Form
  3. Trustmark Universal Life Accelerated Death Claim Form
  4. Trustmark Wellness Claim Form
  5. Trustmark Accident Claim Form

Please refer to each insurance company's web site for additional forms not found here.

The School District of Osceola County, Florida, does not discriminate in admission or access to, or treatment or employment in its programs and activities, on the basis of race, color, national origin, gender, age, disability, marital status or genetic information in its educational programs, services or activities, or in its hiring or employment practices. The District also provides equal access to its facilities to the Boys Scouts and other patriotic youth groups, as required by the Boys Scout of America Equal Access Act.

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