Man at computerBenefits Forms

Looking for a benefits form? You can find several for the following categories:

Flexible Spending Account (FSA) Reimbursement Forms

You can submit your claims online, through the mobile app or on paper. To submit on paper, please use these forms:

Medical, Dental, Vision & Prescription Reimbursement Forms

To submit a claim for reimbursement for dental, vision and prescription services, visit these websites:

Forms for Newly Eligible Employees

If you are newly eligible for benefits, please contact Human Resources to have a benefits enrollment packet emailed to you. Your online enrollment must be completed and the required documentation delivered to the Human Resource department before the last day of the month in which you become eligible for benefits.

You will be required to submit proof of dependent eligibility for any members of your family you are enrolling onto the insurance. After you complete your enrollment, you will be sent instructions from ADP's Dependent Verification System on how to upload these documents.

Submit the Verification of Other Benefits Information form to Human Resources by: 

  • Fax: (530) 893-6846
  • Or email: ann.welch@enloe.org

Mid-Year Change Forms for Qualifying Events

If you have a qualifying event, please contact Human Resources to have a qualifying event packet emailed to you. Your online qualifying event changes must be completed and the required documentation delivered to the Human Resource Department within 31 days of the date of the qualifying event.

You will be required to submit proof of dependent eligibility for any members of your family you are enrolling onto the insurance. After you complete the qualifying event enrollment, you will be sent instructions from ADP Dependent verification system on how to upload these documents .

Submit the Verification of Other Benefits Information form to Human Resources by: 

  • Fax: (530) 893-6846
  • Or email: ann.welch@enloe.org

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    Drs. Voelker and Lobosky honored with 2014 Physician Legacy Award

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    Drs. Voelker and Lobosky honored with 2014 Physician Legacy Award

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    Drs. Voelker and Lobosky honored with 2014 Physician Legacy Award

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    Drs. Voelker and Lobosky honored with 2014 Physician Legacy Award

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