My Pharmacy Benefits

Enrollment Kits and Forms

Below you will find the new employee kit to use to orientate new employees on their health benefits. During an enrollment period you will find all the necessary information and forms located in this section.

2015 New Employee Enrollment Kit
This kit contains enrollment information for new employees. Please print and share with new employees during their orientation.

Continuation of Coverage Rights Under COBRA
This explains COBRA continuation rights when health benefit plan coverage would otherwise end because of a life event known as a "qualifying" event.

BEACON online enrollment instructions
This document contains instructions for agencies that enroll through Employee Self Service (ESS).

eEnroll online enrollment instructions
This document contains instructions for agencies that enroll through the eEnroll system.

eEnroll online enrollment instructions for retirees
This document contains instructions for HBRs that enroll retirees through the eEnroll system.

Application for Reduction in Force Health Coverage Benefit
This form is used for RIF employees applying for health coverage.

Leave of Absence Form for Non-BEACON Agencies
If you are an employee with a Non-BEACON agency, this form provides options for health benefits while on a leave of absence.

Find a Doctor