Current Employees

Important Information for the Health Saving Account (HSA) click on the link HSA Open Enrollment Meeting 

Important Information from Anthem
Anthem has released information and advice to customers on how to protect themselves from scam email campaigns. Please click on the link to read the Anthem news release:   
Anthem News Release 

A Communications Update from Anthem is available here: Anthem Update 2/12/2014

Below is a list of forms for existing employees. Click a link to go directly to a particular form. All forms are in adobe Acrobat (PDF) format.

Use the "Tab" key to move between fields while completing a form. please complete the form and sign where required prior to mailing or faxing. If you fax the form, please mail the hard copy so that we have your original signature.

Our Mailing address is:

         Attention: Human Resources
         125 East Avenue
         Post office Box 6001
         Norwalk, Ct 06852-6001

Our fax number is:

203-854-4095
Medical Forms
FMLA Forms
ANTHEM ENROLLMENT-MEMBER CHANGE FORM FMLA - Employee
DELTA DENTAL ENROLLMENT FORM
FMLA - Spouse/Family
Anthem Creditable Coverage Letter FMLA - Military
Medco Creditable Coverage Letter FMLA - Poster
AETNA-Life Insurance Beneficiary Designation Form
FMLA - The Employee's Guide
Delta Dental Claim Form  
IPI Dental Claim Form
FSA (Flexible Spending Account) Forms
Anthem Claim Form
Affadavit and Federal 1040 Tax Form Dependent Confirmation
FSA 2017 Enrollment Form- LTD Purpose
FSA 2017 Enrollment Form- Health & Dependent Care
  FSA Reimbursement Form
Personnel Forms  FSA Qualifying Expenses 
Personal Day Request FSA 2017 Booklet 
2016 Federal W-4 Form.pdf  
2016 CT W-4 Form.pdf HSA (Health Saving Account) Forms
Direct deposit form
                   
ESG -HSA Employee Contribution Form  2017
2016 Federal W-4 Form -Address Name Change Only.pdf
2016 CT W-4 Form - Address Name Change Only.pdf             
Custodians - HSA Employee Contribution Form 2017
Miscellaneous Forms Food Service - HSA Employee Contribution Form 2017 
403(B) UNIVERSAL AVAILABILITY NOTICE  Nurses - HSA Employee Contribution Form 2017

Security - HSA Employee Contribution Form 2017
Request for school sponsored field trip (updated) 

Technicians - HSA Employee Contribution Form 2017               
Volunteer Form
NASA HSA Employee Contribution Form 2017
Visiting or Professional Day Request
NFEP 40 Wks. 20 - 29.5 Hrs. - HSA Employee Contribution Form 2017             ​
Contracts NFEP 40 Wks. 30 Plus Hrs. - HSA Employee Contribution Form 2017
CUSTODIAN AGREEMENT Through 6-30-2016
NFEP 52 Wks. 20 - 29.5 Hrs. - HSA Employee Contribution Form 2017
ESG Contract 2012 - 2016
NFEP 52 Wks. 30 Plus Hrs. - HSA Employee     Contribution Form 2017                               

FOOD SERVICE WORKERS AGREEMENT through 2016

NFT - HSA Employee Contribution Form 2017 
NFEP Local 1723 2013-2017  

Holiday Closings
NFT Contract 2016-2019 Employee Holiday Schedules 2016-2017
NFT MOA re SpEd Case Managers
NFT MOA re Extended Day and Time  
NURSE'S CONTRACT 2011-2016  
TECHNICIANS FULL AGREEMENT to 2016  
NASA CONTRACT 2015-2018