Benefit Forms

The following benefit forms have been provided for the use of current employees and dependents.  The Benefit Forms can be viewed and printed using Adobe Acrobat.  All forms must be submitted directly to the Human Resources department.  If you have any problems viewing or printing the forms please notify us via e-mail benefitsupport@tjsisk.com.

     Medical - Anthem Blue Cross/Blue Shield

     Enrollment/Change Form
     Medical Claim Form
     Prescription Drug Claim Form
     Waiver of Insurance Form
     Common Law Affidavit
     COBRA Application
 

     Dental - MetLife

     Enrollment Form
     Change of Status Form
     Claim Submission Form
 

     Life and AD&D - Assurant

     Enrollment/Change Forms