Temporary ID Cards
For Envision Rx, Dental and Vision Temporary ID Cards
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Benefits Enrollment Forms
Health Plan Forms
Life Insurance and Beneficiary Forms
Leave of Absence and Short-Term Disability Forms
- Leave of Absence-Mutual of Omaha: For employees who need time away from work due to a medical condition, including pregnancy, surgery, in-patient admission or absences of more than seven calendar days. Eligibility is the first of the month following one year in a benefits eligible status of 32 hours or more per pay period.
- Leave of Absence-Medical (Self): For employees who still need time away from work due to your own medical condition, including pregnancy, surgery, in-patient admission or absences of more than seven calendar days. If you have not been employed for at least one year, please use this form for applying for a leave of absence.
- Leave of Absence-Family (adoption, foster care): When time away from work is due to placement of a son or daughter for adoption or foster care.
- Leave of Absence- Medical (self -intermittent): When time away from work is due to an employee's own chronic medical condition which causes episodic absences.
- Leave of Absence-Family's Medical Condition: When time away from work is needed to provide care to the employee's spouse, parent or child, either continuous or intermittent.
- Leave of Absence-Personal & Educational: When time away from work is for personal or educational reasons.
- Leave of Absence- Military: When time away from work is due to Reserve or National Guard duty, employee who is a covered service member who is on active duty or call to active duty.
- Leave of Absence-Military (Serious Illness): When time away from work is due to the care of a family member who is a service member with a serious injury or illness.
- Leave of Absence-Military (Qualifying Exigency for Military Family): When a family member (employee) of a military participant who is on active duty or has been called to active duty requires time away from work due to the Family and Medical Leave Act (FMLA).
Workers' Compensation Forms
General Administration Forms