2017 Benefits Information and Forms


2017 Medical Comparison

2017 Monthly Medical Insurance Premiums for Active Employees


Use these forms for changes effective during calendar year 2017. For changes effective during calendar year 2018, use the 2018 forms.

Forms should be submitted to the Benefits section of Human Resource Management at:

433 Bolivar St. Suite 626 New Orleans LA 70112

Fax: 504.568.2212


Enrollment Forms:

Note: These forms should not be used for 2018 enrollments and cancellations. For 2018 enrollment and cancellation forms, visit the 2018 Benefits Annual Enrollment website.  

Health and Prudential Life (GB-01)

Dental and Vision

Financial Protection (United Healthcare Life, Critical Illness Protection, Accident Protection, Long Term Disability, Accidental Death & Dismemberment)

Flexible Spending Accounts

Health Savings Account

Identity Theft Protection

Long Term Care


Evidence of Insurability Forms:

Prudential Life

United Healthcare Life and Long Term Disability

Long Term Care