Kent County Employee Benefits


Benefit Elections Benefit Election Form
HSA Change Form
Employee/Dependent Request to Terminate Benefits
Acceptable Proof of Eligibility Documents
Locating Dependent Documentation
How to Access Your Current Elections
Michigan Nonopioid Directive Form (MDHHS-5793)
Blue Cross Blue Shield BCBS Out of Network Claim Form  
BCBS International Out of Network Claim Form  
HIPAA Release Authorization to Release Information  
Life Insurance Life Insurance Beneficiary Changes  
Life Insurance Conversion Form
Life Insurance Portability Form
Accidental Death and Dismemberment (AD&D) Conversion Form
Family Medical Leave Act Request for Leave of Absence
FMLA Reporting Instructions Packet
Sickness & Accident FMLA/S&A Reporting Instructions Packet
Flexible Spending Change in Status  
Flexible Spending Account Claim Form  
Direct Deposit for Flexible Spending Reimbursement  
Health Care Mileage Reimbursement Form