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.
FSA Claim Forms
Flexible Spending Account claim forms can be downloaded from Alliance Benefit Group. You have until November 15, 2007 to incur allowable expenses for the current plan year. Claims for the current plan year must be submitted no later than December 31, 2007.
Life Insurance Change of Beneficiary Form (PDF) - Use this form to change your life insurance beneficiary. It's very important to complete this form if there is a change in your family status (marriage, birth, divorce, death, etc). The proceeds of your life insurance can only be paid to the person(s) named on your Beneficiary Designation form.
Life Insurance EOI Form (PDF) - This form must be used by Late Entrants into the County Life Insurance plans. Instructions and the form can be printed and when completed should be forwarded to the County Insurance Division at 400 Washington Ave, Rm. 111, Towson, MD 21204. The Mail Stop for the Insurance Division is MS 2105.
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.
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Revised June 26, 2008
Courthouse 