Skip To Main Content

Benefit Forms

Required Employment Forms

Fitness for Duty Form

Required prior to returning to work following an injury, illness, or surgery.

Open Form

Reimbursements & Claims

American Fidelity FSA/HRA Claim

Use this form to manually submit a claim for FSA or HRA reimbursement.

Open Form

WPAS VSP Reimbursement

Standard claim form for vision care reimbursements.

Open Form

WPAS Member-Paid Claim

For out-of-network prescription, dental, or vision claims paid by the member.

Open Form

Caremark Prescription Mail Order

Enroll in mail delivery for prescriptions. More info at caremark.com.

Open Form

Travel Preauthorization

For medical travel expenses outside your locale or to Alaska Regional Hospital.

Open Form

2026 Health Enrollment & Retirement

2026 Health Plan Book

Review full plan details and coverage information before enrolling.

View Guide

Enrollment (ESSA, FEA, FPA)

Please submit supporting documents (marriage/birth certificates) with your form.

Open Form

Enrollment (Non-Represented)

For Non-Represented staff. Make sure to attach any required waiver forms.

Open Form

TRS Tier III Rollover

Submit this form to Empower Retirement for 401k withdrawals or rollovers.

Open Form