Benefit Forms:

• 2025 New Hire Benefit Enrollment & Change Form (electronic version)- (This replaces the manual benefit enrollment form(s) you may receive from Human Resources)  
• 2024 New Hire Benefit Enrollment Link (electronic version) - (This replaces the manual benefit enrollment form(s) you may receive from Human Resources)  
• 2025 Enrollment and Change Form
• 2024 Enrollment and Change Form
• Aetna Health Reimbursement Account (HRA) Reimbursement Form - (Use this reimbursement form for the HRA plan connected to the CDHP Health Plan.)
• Dental: MetLife Claim Form
• Health Care FSA & Dependent Care: Aetna Reimbursement Form - (Use this reimbursement form for the FSA plans - Health Care and Dependent Care Plans)
• HIPAA Form - PCSB
• MetLife HIP Claim Form - Certificate number: GCERT12-AX (Income Tax Considerations)   
• PCS Statement of Benefits
• The Standard Disability Claim Form     
• Vision: EyeMed Out-of-Network Claim Form  
  
  

Life Insurance Forms:

• The Standard - Life Insurance Instructions and Online Application link (Online Application only)

Disabled Dependent Information:

• Aetna Request for Continuation of Coverage for Disabled Child - (Return Form to Aetna at Arroyot@aetna.com or fax to 860-907-2912)   
• Aetna Disabled Child Attending Physician Statement - (Return Form to Aetna at Arroyot@aetna.com or fax to 860-907-2912)   
  (Note: Please do not return the Aetna form using the information on the form - use the email we indicate above.)
• The Standard Continued Dependent Life Insurance - (Continuation of Child Life Insurance coverage only).
• Pinellas County Schools Handicapped Dependent Form - (Continuation of dental and vision coverage only. Not required if submitting Aetna forms).

(Note: If Pinellas County Schools changes insurance providers in the future, new documentation may be required for approval to be on that company's plan.)

Retirement Forms:

• Voluntary Retirement Programs 403(b) and 457(b) Plans - (Forms are located at the bottom of the page)
  For information on retirement options and to access retirement forms, please visit the Retirement Page.