Add/Remove Coverage or Dependents
You will need to complete a Health Benefits Change Form if you wish to add/remove dependent(s) from your health plans. Supporting documentation will be required. A completed Health Benefits change form must be received by Health and Wellness within 30 days of a permitting event, unless otherwise noted in the Health Benefits Eligibility Policy.
You will need to complete a Health Benefits Enrollment Form if you wish to add coverage or a Health Benefits Declination Form if you wish to remove coverage. Supporting documentation will be required. The completed form must be received by Health and Wellness within 30 days of a permitting event, unless otherwise noted in the Health Benefits Eligibility Policy.
Important Notes
- You must have an account for the online forms platform in order to submit a form. Create an account
- As of January 2021, the enrollment forms no longer work with Internet Explorer. If you do not have another browser installed on your work PC, you can fill out a form from your home PC, smart phone, or tablet.
- If you have questions about how to fill out the below forms, see the Health Benefits Online Forms FAQ.
Health Benefits Change Form for Active Employees
Health Benefits Enrollment Form for Active Employees
Health Benefits Declination Form for Active Employees
Change Beneficiary on the County-Paid Life Insurance
You will need to complete a new Beneficiary form, if you wish to change your beneficiary on the County-Paid Life Insurance. Kern County will always use the most recent dated Life Insurance Beneficiary from on file.
Submit a Reimbursement from your Flexible Spending Account
If you wish to submit a claim for reimbursement to your Medical or Dependent Care Flexible Spending Account, you can complete a Flexible Spending Account Reimbursement Claim Form, or submit a claim electronically through the AFmobile app or on the web through the American Fidelity Member Portal. More information can be found on the Flexible Spending Accounts page.
Please note it can take up to 10 business days for a claim to be processed if you submit the reimbursement claim form.
Voluntary Benefits - Voya Life Insurance Beneficiary Form
This form is only for those employees who are enrolled in the Voluntary Benefit Group Life Insurance with Voya. You may designate or change your beneficiary by completing the form and submitting the original to Health Benefits. Please make sure to keep a copy for your records.
