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Enrollment Information/Agency Forms

Active Employees

Medical and Dental Enrollment

Online Enrollment
Employees on the State Controller's payroll system can enroll in or make changes to their medical, vision, and dental coverage using this online enrollment program.

Enrollment form
Employees of Idaho State University, Boise State University, and other entities not on the State Controller's payroll system can use this form to enroll in, or make changes to, their medical, vision, and dental coverage. You can print this form out, complete it, and turn it in to your payroll office.

Premium Only Plan

FSA Enrollment form - complete this form if you have had a family status change allowing a change in your contributions.

For those on Biweekly payroll
For those on Monthly payroll

FSA Claim form - print and fill out this claim form to submit an FSA claim

Basic and Supplemental Life Insurance Enrollment/Beneficiary Designation Form

State Police Optional Life Insurance Enrollment Form

Beneficiary Designation/Change/UTMA

Forms For Agencies

Medical self pay form

Dental self pay form

Basic life self pay form

Supplemental life self pay form

Basic Life Premium Reconciliation

FSA Contribution form