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Forms

Health Plan
TRS-ActiveCare
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Plan Descriptions
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Forms
Filing a Claim
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Changing Benefits

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Flexible Benefit Program
Plan Documents

Click here for "Claim Forms and Instructions"

Flexible Spending Account:

Medco Prescriptions:

Cancel Life Insurance PDF file (10 KB) - Life insurance may be canceled anytime. Return completed form to the PISD Benefits department.

Life Insurance - SunLife

  • Application Form PDF file (290 KB)
    • Return completed form to the PISD Benefits department.
  • Online health questionnaire Opens new window
    • Click on Evidence of Insurability Application, follow the instructions, review your answers, and sign your application electronically before you submit.
    • Everyone requesting life insurance must complete the health questionnaire, EXCEPT new employees who are enrolling within 31 days from their hire date and are requesting $250,000 or less.
  • Beneficiary Change Form Opens new window
    • Return completed form to the PISD Benefits department.

Disability Insurance:

TRS-ActiveCare Forms:

Application to Split Premium PDF file (188 KB) - Use this form ONLY if you and your spouse work for different school districts and you qualify to split the family premium. Do not use this form if you and your spouse both work for PISD.

Dependent Child's Statement of Disability PDF file (182 KB) - Use this form if you will be requesting TRS-ActiveCare medical coverage for a disabled child over age 25.

Transitional Care Request Form PDF file (171 KB) - Use this form if you will be using a non-network doctor under TRS-ActiveCare. The criteria to qualify for transitional care are explained in the TRS Benefits Booklet on page 38.