FORMS
BENEFICIARY
To update a beneficiary, please visit hrsystems.azdoa.gov > Y.E.S. Portal.
ENROLLMENT FORMS & GUIDES | 2021
For active employees, enrollment is entirely online via hrsystems.azdoa.gov > Y.E.S. Portal.
Active Employees - 2021
- Guides
- Active Enrollment Guide 2021 - Guide with enrollment instructions and a simple explanation of each benefit - includes current rates.
- Active Benefits Guide 2021 - An in-depth look at your benefits to help you use your plan effectively - includes current rates.
- Forms
- Qualified Life Event (QLE)
Retirees/LTD - 2021
- Guides
- Retiree Enrollment Guide 2021 - Guide with enrollment instructions and a simple explanation of each benefit - includes current rates.
- Retiree Benefits Guide 2021 - An in-depth look at your benefits to help you use your plan effectively - includes current rates.
- Forms
COBRA
- Visit the COBRA tab
QUALIFIED LIFE EVENTS | QLE
- Please see our Qualified Life Events page for forms and filing information.
- Age 26 Dependent Termination Process
FLEXIBLE SPENDING ACCOUNTS | FSA
- FSA Enrollment Form - Triple Choice Plan | Health Care | Dependent Care - 2021
- FSA Enrolment Form - High Deductible Healthcare Plan (HDHP) | Limited Purpose Dental and Vision | Dependent Care - 2021
HEALTH CARE SPENDING ACCOUNT | HSA
For use with a high deductible healthcare plan (HDHP).
2021 Forms
- HSA Payroll Deduction Authorization Form - 2021
- How to Calculate HSA Contributions and Maximum Contributions - 2021
- HSA Contribution Cancellation Request Form
- HSA Excess Contributions and Deposit Correction Form
- HSA Transfer Account to Optum Bank Form
MEDICAL
PHARMACY
MedImpact - Active
Vibrant Rx - Retiree
