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office hours
Monday – Thursday
8:00am – 11:30am
Closed
11:30am-12:30pm
Re-open
12:30pm-5pm
Fridays
8:00am-11:30am
Closed
11:30am-12:30pm
Re-open
12:30am-4:00pm
bcbsnm contacts
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Benefits
» Forms
Benefits Forms
Health and Insurance
Full-Level Insurance Enrollment Form (1751a) (pdf)
Beneficiary Designation/Change Form (1938) (pdf)
Delta Dental Claim Form (pdf)
BCBSNM Downloadable Forms
(Medical Claim Reimbursment/PrimeMail prescription Drug Mail-Order/Prescription Drug Claim Form, etc.)
PayFlex Downloadable Forms
(Healthcare Reimbursement Accounts/Dependent Care Reimbursments Accounts)
Domestic Partnership
Declaration of Domestic Partnership (1925a) (pdf)
Domestic Partner: Termination of (1925c) (pdf)
Cobra Information
Department of Labor - COBRA
Family and Medical Leave
Certification of Health Care Provider (1786) (pdf)
Certification of Military Caregiver Leave for Military Family Leave (FMLA) (1992) (pdf)
Certification of Qualifying Exigency for Military Family Leave (FMLA) (1993) (pdf)
Designation of Family Medical Leave (1784) (pdf)
Designation of Family and Medical Leave by Manager (1787) (pdf)
Employee Request for Family and Medical Leave (1621) (pdf)
Family and Medical Leave Notification (1785) (pdf)
Benefits Forms
Designating Beneficiaries
Fidelity Investments
Summary Plan Descriptions
UC's Benefits & Policies
Los Alamos National Laboratory
• Est 1943
