Enrollment Forms

» About Pima » Administration » Administrative Departments / Initiatives » Employee Services » Benefits » Enrollment Forms

Much of the information requested on the forms can be entered online before printing the form. You can also print the forms and fill them out in ink or call the Employee Service Center and request printed copies. After printing, review your information, then sign and date the form. Use MyPima to check current coverage . Choose: Employee -- Benefits and Deductions.

2009/2010 Benefits Enrollment Forms

Plan Year July 1, 2009 - June 30, 2010

Medical and Dental Care

Medical Enrollment Form (PDF File)
Dental Enrollment/Change Form (PDF File)

Insurance Waiver Form

Insurance Waiver Form (PDF File)

Flexible Spending Accounts

Supplemental Life Insurance

Sun Life Group Basic Enrollment Form
Sun Life Application for Additional Insurance (optional) (PDF File)
Sun Life Evidence of Insurability Form (PDF File)
Sun Life Beneficiary Designation

Tax Deferred Annuities (403b and 457 plans)

Retirement Plans

Arizona State Retirement System (ASRS) (PDF)
PCC Optional Retirement Plan (ORP) (PDF)
- Instructions for enrollment
- Employee enrollment form
TIAA-CREF application

Other Forms

Go to HR Benefits: Other Forms