Savannah River Site
11/08/2023
 

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Active Employee Benefits
Forms

Medical Forms   Dental Forms
5-200

Health Care Programs Enrollment Change
(if PDF doesn't open in browser,
right click and choose "save link as")

  5-200 Health Care Programs Enrollment Change
(if PDF doesn't open in browser,
right click and choose "save link as")
5-340 Medical Claim Form   5-342 Dental Claim Form
-- Prescription Drug Claim Form       
-- Mail Service Order Form      

Vision Forms
 
Flexible Spending Account Forms
5-200 Health Care Programs Enrollment Change   5-343 Health Care Flexible Spending Account Reimbursement Form
5-352 EyeMed Vision Care Out Of Network Claim Form   5-344 Dependent Care Flexible Spending Account Reimbursement Form

Life Insurance
 
Time Bank

To obtain a Life Insurance Beneficiary Form call:
Prudential Life Insurance
1-844-494-4778

  5-346 Donor's Timebank Transfer Request
Any Benefits content questions contact the Benefits Solutions Service Center at 803-725-7772 or 800-368-7333
or via email at service-center@srs.gov


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SRS Operator: 803-725-6211
SRS Status & Emergency Information  Visitor/Vendor Briefing
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