Applications and Forms for Employees
Find the forms you need to enroll in, change or manage your health insurance through your employer's CCSB plan.
Enrollment and Change Request Forms
The combined enrollment and change request form lets you submit a new enrollment request or make changes to your existing insurance on one form. Separate enrollment and change forms are also accepted.
2026 Forms
2025 Forms
Need help with employee forms?
Our team can help you find the right form or answer questions about your health or dental insurance.
COBRA Forms
If you lose group health insurance coverage — for example, due to losing your job, reduced hours, or leaving the company — COBRA may allow you to continue that coverage temporarily. Use the documents below to elect, cancel or understand your COBRA rights.
For more information, visit Department of Labor’s COBRA Continuation Coverage page
Member ID Card
People who have a health or dental plan through CCSB can find insurance company-specific steps on how to access or order a member ID card (PDF) . It’s most helpful when someone needs proof of insurance for an appointment, pharmacy visit, or a mailed replacement card.