Dental and Vision Enrollment Change Form

*Please Note*

Review the following situations and if applicable, submit the required documentation.

1. If you are not making changes, no action is needed.
2. If you are only changing your plan, you do not need to list your currently enrolled dependents. Documentation for dependents already enrolled in County benefits does not need to be re-submitted.
3. If you are adding a spouse, domestic partner, and or child dependent, you must include the required Supporting Documents.