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Benefit Forms & Information

Tuition Reimbursement

Leave of Absence

Healthcare Provider Forms
NOTE: It is important that the department personnel officer is immediately made aware of any leave in order to comply with Federal notice regulations under the Family Medical Leave Act.


General Health Benefit Plan Information

Benefit Forms

Medical / Prescription Drug, Dental & Vision

Flexible Spending Accounts (FSA), Health Savings Accounts (HSA), Health Reimbursement Accounts (HRA) & Retiree Medical Savings Accounts (RMSA)

FSA Enrollment Forms:

Life Insurance

Other Value-Added Benefits and Voluntary / Supplemental Benefits

IMPORTANT Health Plan / Employee Rights Notices

Frequently-Used Links

Wayne County Retiree Stipend Program