Use this form when enrolling in Flexible Spending Accounts.

Don't have access to a printer? Use this form to submit your vision claim reimbursements.

Updated rates increased 11/15/2019

Use this form to convert your Mutual of Omaha Life Insurance policy.

If you plan to port your Mutual of Omaha Life Insurance, use this form.

Use this form for vision claim reimbursements in 2020.

This form is for retirees making enrollment changes in 2020.

Be sure to use this form for any 2019-2020 active enrollment changes.

This form is used when you are adding a spouse to the medical plans.