Open Enrollment Information and Forms

The month of May is designated as an open enrollment period for health, dental and related dependent care and medical expenses covered under the IRS125 plan.

If you have been thinking of making any changes in your provider or family status, May is the only month in which you are allowed to make these changes without the benefit of a qualifying event.

The deadline for enrollment changes is Wednesday, May 22, 2019.

Health and dental insurance premium rates, informational brochures, declination forms and enrollment forms are currently available in the main office of each building.

If you are making changes, please submit to the forms to the business office.

If you have any questions, you should contact the Human Resource Dept. at 347-3600 ext. 73106 or email: The Human Resource Department days and hours are: Monday-Thursday, 8:30 a.m. – 2:30 p.m.

The forms below are provided in PDF format. If you encounter any difficulty attempting to access these files, contact Robert Hanlon at (518) 386-4343 or (518) 347-3600, ext. 71111, or email

Forms and Downloadable Information


  • Blue Shield PPO
  • Blue Shield Point of Service
  • CDPHP Universal Benefits
  • Flexible Spending Accounts