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
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)