Shaping the future together
Enrollment
New Dependent
Dependent Cancellation
Status Change
Declination of Coverage
Wellness Provider Screening
Patient Pre-Screening Questionnaire
Enrollment, Change, & Termination of Coverage
Flex Reimbursement Form
Flex Online Portal Setup
Enrollment, Change, Beneficiary Update, & Termination of Coverage
Beneficiary Change
Other ERS Forms
RSA-1
Enrollment Packet
Beneficiary Designation
Investment Elections for Existing Accounts
Authorization to Defer Compensation
Nationwide
Enrollment/Change
Divorce Proceedings
Portal Address Change (See Personal Information Section)
Direct Deposit (Visit Portal)
Pre-Tax Authorization
Federal W-4
State A-4
Leave Transfer
Sick Leave Bank Enrollment
Sick Leave Bank Recipient Application
Medical Emergency Certification (Sick Leave Bank)
Certification of Health Care Provider for Family Member’s Serious Health Condition
Certification of Health Care Provider for Employee’s Serious Health Condition
FML & Paid Parental Leave Request
FFCRA Leave Requests
Reasonable Accommodation Request
Request for Temporary Transitional Light Duty
Outside Employment Request
Personnel Transfer
Reclassification Request
Request for Appeal
Termination and Department Out-Processing
Disciplinary Action Report
Notice of Employee Disciplinary Hearing
Telework Arrangement Notification
Supervisor resources located at: https://www.madisoncountyhr.org/supervisor-resources
