Forms and Documents
FY24 Benefits Guide
Note: FY24 Claim forms for Hospital Indemnity, Accident, and Short-Term Disability can be found on the MetLife Microsite. FY23 Vision claim forms can be found on the EyeMed Microsite or the Vision Page.
Please Note: If you need to make a change to the amount deducted for an HSA, please call the Benefits Division at 605.773.3148 or email email@example.com to request the proper form.
- HRA & FSA Claim Form
- Dependent Spending Account Recurring Claim Form
- Deductible Verification Form
- HSA Distribution Request Account Closure Form
Discount and Lifestyle Programs