Forms
Benefits Change Form (PDF) - This form should be used during the year when you have a change to your benefits status (i.e. birth of a child, marriage, etc.). Complete this form online then print a copy of the form. Sign and date the completed form and attach documentation for your requested change. You can then fax the form and document(s) to Baltimore County's Insurance Division at 410-887-3820, mail the form inter-office to MS 2105 or mail to the Insurance Division at 400 Washington Ave, Rm 111, Towson, MD 21204.
Benefits Change Form (Word) - This form also available as a word document.
Retiree Benefits Application (PDF) - This form can be printed and sent to the address in the bottom right corner for retirees making a change to their benefits.
FSA Claim Forms
Flexible Spending Account claim forms can be downloaded from Hirsch Financial Services (HFS). You have until March 15, 2012 to incur allowable expenses for the current plan year. Claims for the current plan year must be submitted no later than April 30, 2012.
Revised September 26, 2011
