Enrollment Materials for Employees

The following enrollment materials will assist you with your enrollment decisions. You may also obtain an Enrollment Guide, Medical Plans Comparison chart and enrollment/change forms from your HR liaison.

Win for Life Enrollment Guide (pdf)

SMART Guide for Healthcare Flexible Spending Account (pdf)

HFSA Worksheet (pdf)

HFSA Medical Necessity form (pdf)

HFSA Direct Deposit form (pdf)

HFSA Claim form (pdf)

HFSA Expense Tracking form (xls)

Win for Life Comparison Chart (pdf)

Fact Sheet (pdf)

Enrollment Materials for Retirees

The following enrollment materials will assist you with your enrollment decisions. You may also obtain an Enrollment Guide, Medical Plans Comparison chart and enrollment/change forms from the benefits division.

Win for Life Enrollment Guide (pdf)

HMO Plans Comparison Chart (pdf)

PPO, POS and PFFS Plans Comparison Chart (pdf)

Supplement F Comparison Chart (pdf)

Fact Sheet (pdf)

Employee Guide | Retiree Guide | HFSA (SMART) Guide | Home | Mayor's Letter
Enrollment Materials | Important Dates | Contacts