• Home
  • ENROLL
  • Healthcare & Well-Being
  • Financial & Retirement
  • Resource Center

Forms

Forms

  • Dependent Verification Form
  • Domestic Partner/Common Law Spouse Affidavit
  • Spousal Surcharge Form
  • Tobacco Verification Form
  • Request for Accommodation Medical Exemption from Vaccination rev2


Teamcare Benefit Enrollment Materials (for Bridgeport Union use only)

  • TeamCare Enrollment form
  • TeamCare Plan MH Benefit Summary
  • 2021 & 2022 TeamCare Coverage Rates
  • Inframark Enrollment Change form
Contact Us
  • Home
  • ENROLL
  • Healthcare & Well-Being
  • Financial & Retirement
  • Resource Center

Copyright My Inframark Benefits © 2022, All Rights Reserved | Privacy | Terms of Use


    ×