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Benefit Forms

Look below for Health, Dental, Vision, Flexible Spending, Workers Comp, FMLA and other leave forms.
Please contact Laura Corley at 706-865-2315 x 1701 or email laura.corley@white.k12.ga.us with any questions.
See SHBP Legal Notices in the SHBP folder below.
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Affordable Care Act Notice 10/1/2013  1062k v. 2 Dec 6, 2016, 8:05 AM Laura Corley
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Dental Plan Documents  204k v. 2 Dec 6, 2016, 7:56 AM Laura Corley
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Dental Plan Documents  189k v. 2 Dec 6, 2016, 7:56 AM Laura Corley
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FMLA - Employee Request Form for Self, Spouse, Parent or Child  139k v. 2 Dec 6, 2016, 7:51 AM Laura Corley
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Long Term Leave Request Form  292k v. 2 Dec 6, 2016, 8:05 AM Laura Corley
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FMLA - Physician Statement  190k v. 2 Dec 6, 2016, 7:45 AM Laura Corley
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Flexible Spending Account Forms and Documents  179k v. 2 Dec 6, 2016, 8:06 AM Laura Corley
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Flexible Spending Account Forms and Documents  1957k v. 2 Dec 6, 2016, 8:06 AM Laura Corley
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Flexible Spending Account Forms and Documents  141k v. 2 Dec 6, 2016, 8:06 AM Laura Corley
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  3074k v. 2 Dec 6, 2016, 8:14 AM Laura Corley
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  17k v. 2 Dec 6, 2016, 8:14 AM Laura Corley
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Create online Social Security Account  620k v. 2 Dec 6, 2016, 8:07 AM Laura Corley
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  1333k v. 3 Dec 6, 2016, 8:26 AM Laura Corley
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2017 Active Employee Benefits Presentation  328k v. 2 Dec 6, 2016, 7:56 AM Laura Corley
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2017 SHBP Enrollment Form  352k v. 2 Dec 6, 2016, 7:56 AM Laura Corley
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2017 ACTIVE EMPLOYEE DECISION GUIDE  2105k v. 2 Dec 6, 2016, 7:56 AM Laura Corley
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2017 ACTIVE EMPLOYEE SHBP RATES  12k v. 2 Dec 6, 2016, 7:56 AM Laura Corley
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Sick Leave Bank Form  122k v. 2 Dec 6, 2016, 8:07 AM Laura Corley
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VSP Vision Plan Info  63k v. 2 Dec 6, 2016, 7:56 AM Laura Corley
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VSP Vision Plan Claim Form  157k v. 2 Dec 6, 2016, 8:17 AM Laura Corley
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Worker's Compensation Forms   219k v. 2 Dec 6, 2016, 8:19 AM Laura Corley
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FY17 WCSS Work Comp Panel of Physicians   97k v. 2 Dec 6, 2016, 8:19 AM Laura Corley