You may add or remove a dependent in the event of a qualified status change. You are encouraged to review the status change definitions before downloading the form; in some cases supporting documentation is needed. You must add or remove a dependent within 31 days of the status change.
To add or remove a dependent from your coverage, please log onto our enrollment system, bSwift (www.scripps.bswift.com) using your user ID and password. Click here for a bSwift user guide. You must also provide proof of dependency if adding a dependent to the plan. For additional bSwift support, please contact Benefits Administration at 858-784-8487.
Aetna Medical Reimbursement Form (PPO, HDHP PPO, HMO,EPO, Graduate Student Plans only)
Aetna Prescription Claim Form (HMO and EPO Plans )
OptumRx Prescription Mail Order Form (PPO, HDHP PPO, and Graduate Student Plans Only)
OptumRx Prescription Reimbursement Claim Form (PPO, HDHP PPO, and Graduate Student Plans Only)
Medical Waiver Form (All Medical Plans)
Medical Eye Services Vision Claim Form (California Participants only)
All FSA claims are filed online at www.PayFlex.com
Delta Dental Reimbursement Form
Cash Balance Beneficiary Designation Form
Fidelity Investments Beneficiary Designation Form
Fidelity Distribution Automatic Payments Form
Fidelity Distribution Cash Payout Form
Fidelity Investments Beneficiary Designation Form
Fidelity Transfer/Rollover/Exchange Form
Fidelity Distribution Automatic Payments Form
Fidelity Distribution Cash Payout Form
Fidelity Distribution Rollover Form
Fidelity Investments Beneficiary Designation Form
Fidelity Investments Beneficiary Designation Form
Fidelity Transfer/Rollover/Exchange Form
Fidelity Distribution Automatic Payments Form
Fidelity Distribution Cash Payout Form
Fidelity Distribution Rollover Form
Injury/Illness/Incident Report
Prudential Group Term Life Beneficiary Form
Transit Benefit Enrollment Form
Prudential Voluntary Life/AD&D Beneficiary Form