Forms

Medical

Spousal Coordination of Benefits Form
Dependent Coordination of Benefits – Aetna
Dependent Coordination of Benefits – BCBS
HIPPA

Vision

VBA Benefit Summary
VBA Member portal
VBA Vision ID Card
Progressive & Hearing VBA member flyer
VBA Out-of-Network Reimbursement

Long-Term Disability

Cigna LTD Claim Process
Cigna LTD Claim Form
LTD Insurance Certificate
Hartford LTD Claim Form

State Group Accident and Illness Insurance

Add How to File a Claim

Dental

Cigna Dental Benefit Summary Plan A
Cigna Dental Benefit Summary Plan B
myCigna.com
Cigna Dental ID Card

Life & AD&D Insurance

Group Life Conversion
Certificate of Insurance

Effective July 1, 2026, MetLife will be our new Basic Life and AD&D Plan Administrator.  More information will be added to the website soon.

ASI Flexible Spending Accounts

Flexible Spending Account Claim Form