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  • My Winn Benefits | 2023
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  • myHealth Health
    • Medical and Prescription
      • Overview
      • Eligibility
      • $1,250 PPO Plan
      • $1,850 PPO Plan
      • $3,000 PPO HDHP with HSA
      • Kaiser HMO Plans
      • Find a Doctor
      • Prescriptions
      • Telehealth
      • Life Events
    • Voluntary Medical Benefits
      • Overview
      • Critical Illness Insurance
      • Hospital Indemnity Insurance
      • Voluntary Accident Insurance
    • Dental
    • Vision
    • Health Savings Account
      (HSA)
    • Flexible Spending Accounts (FSAs)
      • Overview
      • Health Care FSA
      • Dependent Care FSA
      • Compare FSAs
      • How to File a Claim
      • FSA Store
      • FSA Savings Calculator
    • Disability, Life & AD&D Insurance
      • Overview
      • Long-Term Disability (LTD)
      • Short-Term Disability (STD)
      • Basic Term Life and AD&D
      • Permanent Life
      • Supplemental Term Life
    • Wellness
      • Overview
      • Emotional Wellness Support
      • Employee Contribution Discount
      • Personal Health Assessment
      • Resources
    • Employee Assistance
      Program
    • Health Advocate
  • my Wealth Money
    • Pay & Rewards
      • Overview
    • 401(k) Savings Plan
    • Additional Benefits & Discounts
      • Overview
      • Commuter Benefits
      • Identity Theft Protection
      • Auto and Home Insurance
      • Legal Plan
      • Pet Insurance
      • Team Member Discounts
      • Employee Referral Award
      • Anniversary Service Awards
      • Travel Assistance
      • Health Club Reimbursement
      • BCBS Wellness Resources
  • my Life New Hires
    • Benefits Enrollment
      • Overview
      • Eligibility
      • Checklist
      • Plan Comparisons
      • How to Enroll
  • MyCareer Time Away From Work
    • Time Off
      • Overview
      • ATO
      • Sick Time
      • Holidays
      • Day of Service
      • Other Time Off/Leaves of Absence
  • my Team Tools & Resources
    • Forms
    • Documents
    • Glossary
    • Contacts
  • Forms
  • Documents
  • Contacts
forms & policies

Forms

Overview

Use the following forms to manage your benefits.

  • BCBS Mail Order Pharmacy Form
  • Fitness Reimbursement Form
  • Fitness Reimbursement Form (Spanish)
  • HSA Beneficiary Designation
  • Primary Care Physician
  • Request Family Medical Leave of Absence

Health

  • Medical and Prescription
  • Voluntary Medical Benefits
  • Dental
  • Vision
  • Health Savings Account
    (HSA)
  • Flexible Spending Accounts (FSAs)
  • Disability, Life & AD&D Insurance
  • Wellness
  • Employee Assistance
    Program
  • Health Advocate

Money

  • Pay & Rewards
  • 401(k) Savings Plan
  • Additional Benefits & Discounts

New Hires

  • Benefits Enrollment

Time Away From Work

  • Time Off

Tools & Resources

  • Forms
  • Documents
  • Glossary
  • Contacts
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