Benefit Forms

Aetna Health Insurance Disabled Dependent Forms:

• 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.

Benefit Forms:

• 2026 Benefits Enrollment & Change Form - (this replaces the manual benefit enrollment form(s) you may receive from Human Resources)
• Inspira Health Care FSA & Dependent Care Reimbursement Form - (use this reimbursement form for the FSA plans - Health Care and Dependent Care Plans)
• Inspira Health Reimbursement Arrangement (HRA) Claim Form - (use this reimbursement form for the HRA plan connected to the CDHP Health Plan)
• The Standard Electronic Medical History Statement On-line Instructions
• MetLife Dental/HIP Insurance Coverage - (continuation of Dependent MetLife Dental Insurance or Dependent MetLife HIP Plan)
• MetLife HIP Claim Form - Certificate number: GCERT12-AX (Income Tax Considerations) 
• Pinellas County Schools Handicapped Dependent Form
• Pinellas County Schools HIPPA Form
• The Standard's Disability Claim Form

Dental & Vision Disabled Dependent Forms:

• Humana Disabled Dependent Continuation of Coverage
• MetLife Dental Insurance Coverage - (continuation of Dependent MetLife Dental Insurance or Dependent MetLife HIP Plan)   
• Pinellas County Schools Handicapped Dependent Form - (if only enrolled in Dental and/or Vision, this form is required)

Note: If Pinellas County Schools change 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.

The Standard Life Insurance Forms:

• The Standard - Life Insurance Instructions and Online Application link (online application only)
• The Standard Continued Dependent Life Insurance - (continuation of Child Life Insurance Coverage only)