Resources
Forms
The following forms must be signed via Docusign only. Please contact our office for access to:
- Certification of Financial Dependency of Grandchildren
- Direct Debit Authorization Agreement
- Harris County Retiree Health & Related Benefits Change Form
- Health and Related Benefits Waiver – Retirees
- Health and Related Benefits Waiver – Active Employees
- Insurance Deduction Authorization for Public Safety Officers
- Retiree Life Insurance Beneficiary Update Form
Plan and Legal Documents
- AETNA MAX SAVINGS PROGRAM
- GROUP LONG TERM DISABILITY CERTIFICATE
- MODEL NOTICE FOR EMPLOYERS WHO OFFER A HEALTH PLAN TO SOME OR ALL EMPLOYEES
- MODEL NOTICE FOR EMPLOYERS WHO OFFER A HEALTH PLAN TO SOME OR ALL EMPLOYEES – SPANISH VERSION
- AETNA SUMMARY OF BENEFITS – BASE PLAN
- AETNA SUMMARY OF BENEFITS – PLUS PLAN
- TERM LIFE AND AD&D INSURANCE CERTIFICATE – ACTIVE EMPLOYEES
- TERM LIFE INSURANCE – RETIREES
- DENTAL SUMMARY PLAN DESCRIPTION (2025)
- DENTAL CERTIFICATE RIDER (2025)
- RETIREE HEALTHCARE REINSTATEMENT POLICY (2024)
- AETNA CHOICE POS II MEDICAL PLAN (2025)
- AETNA CHOICE POS II BASE PLAN (2025)
- AETNA CHOICE POS II PLUS PLAN (2025)
- AETNA KELSEYCARE HEATH NETWORK ONLY PLAN (2025)