Benefit Forms & Information
- AETNA Summary of Benefits and Coverage (01/01/2019-12/31/2019)
- AETNA Summary of Benefits and Coverage (01/01/2018-12/31/2018)
- AETNA Enrollment/Change
- AETNA Medical Benefits Request
- Annual Certification of Spouse and Dependent Eligibility (online)
- Annual Certification of Spouse and Dependent Eligibility (screen shots)
- Annual Certification of Spouse and Dependent Eligibility (form)
- Spousal and Dependent Eligibility Rule
- Spousal and Dependent Eligibility Rule Flow Chart
- Spousal and Dependent Certification Flow Chart
- Certification of Dependent Child
- Certification of Marriage
- Health Benefit "Buy In" Agreement
- CSEA Dental Claim
- CSEA Vision Claim Form
- Direct Reimbursement Claim
- Domestic Partner Policy
- LETF Optical Raymond Opticians Claim
- LEFT Dental Claim Form
- LETF Student Dependent Certification
- Department of Labor New Health Insurance Marketplace Coverage Options
- Medicare Members Prescription Drug Coverage & Medicare Infomation
- Putnam/Northern Westchester Health Benefits Consortium Plan Document
- Open Enrollment for District Medical Insurance Plan
- CanaRx/PNWMeds Meds Employee Program website