Categories
2025 – 2026 Active Enrollment Form
The Active Enrollment Form is used for any changes for employee enrollment.
2025-2026 Family Status Change Form
If you have a family status change, or qualifying event, use the forms to complete the enrollment.
Retiree Special Open Enrollment – Spousal Affidavit
Use this form if you have a spouse on Retiree Medical for changes during the Retiree Special Open Enrollment.
Retiree Special Open Enrollment – Benefits-at-a-Glance Booklet
This is the Retiree Special Open Enrollment Booklet.
Retiree Special Open Enrollment – Memo for those who have Retiree Life Insurance ONLY
If you have only Life Insurance as a Retiree, this memo is for you.
Retiree Special Open Enrollment – Memo for those in Medical/Dental/Vision/Life
This memo is for Retirees with Medical, Dental, Vision, and Life.
Retiree Special Open Enrollment – Memo for those who have Retiree Life Insurance ONLY
If you have only Life Insurance as a Retiree, this memo is for you.
Retiree Special Open Enrollment – Memo for those in Medical/Dental/Vision/Life
This memo is for Retirees with Medical, Dental, Vision, and Life.
Wellness Program Notice
See attached for the Wellness Program Notice
Retiree Special Open Enrollment – Spousal Affidavit
Use this form if you have a spouse on Retiree Medical for changes during the Retiree Special Open Enrollment.
Retiree Special Open Enrollment – 2025 Enrollment Form
Use this form for the Retiree Special Open Enrollment!
Added Benefit – Additional EAP Services through Voya!
As an added benefit for all employees through Voya, you can access their Employee Assistance Program (EAP) services at no additional cost to you!
Florida Blue Gym Discounts & More!
Check out fitness discounts, nutrition programs and more through Blue365!
Preferred Benefits Administrators – Setting Up Your Account
This flyer will assist you with setting up your account with PBA online.