Forms and Documents

FY24 Benefits Guide

• FY24 Benefits Guide – Downloadable PDF | Online Flip Book

Claim Forms

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 benefitswebsite@state.sd.us to request the proper form.

• HRA & FSA Claim Form
• Dependent Spending Account Recurring Claim Form
• Deductible Verification Form
• HSA Distribution Request Account Closure Form 

• Preventive Drug FAQ 

Discount and Lifestyle Programs

• MyLifeLink
• RX Outreach
• Working Advantage