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Randolph County

Forms

Administrative Forms

Aflac Service Request
AUL Portability Request
AUL Service Request
FBA Change of Address
FBA Change of Status
FBA Debit Card Election Form
FBA Direct Deposit Form
Manhattan Life Policy Change
MetLife Beneficiary Designation
MetLife Portability
MetLife Standard Life Statement of Health
Trustmark Designation Form
Trustmark Full Surrender Form
Trustmark Name Change Form

Claim Forms

Aflac Accident
Aflac Critical Illness
Ameritas Dental
AUL Long-Term Disability
AUL Maternity
AUL Short-Term Disability
EyeMed Out of Network Claim
FBA Dependent Care Reimbursement Claim Form
FBA Medical Reimbursement Claim
Manhattan Life Cancer
MetLife Standard Life Claim
Trustmark Death Benefit Claim

Wellness Benefit Forms

Aflac Accident Wellness
Aflac Critical Illness Wellness
Manhattan Life Cancer Wellness

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Disclaimer

All information contained in this website is a brief description of your coverage and is not a contract.  Please read your certificate or policy for each product for the exact terms and conditions of each product.  If you cannot find the policy certificate please reach out to us on the contact page.

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  • Home
  • Benefits Guide
  • Benefit Plans
  • Product Videos
  • Forms
  • Policy Information
  • Enrollment
  • Contact Information