Mountaineer Flexible Benefits Enrollment Form (Active Employees)
Mountaineer Flexible Benefits Enrollment Form (Retirees)
Please note, to update your Mountaineer Flexible Benefits elections after a change-in-status event, you must complete an Enrollment Form with FBMC. Employees must submit the form, as well as supporting documentation, to their Agency Benefit Coordinator within the month of or two months following the status-changing event. Please select the appropriate Enrollment Form above (Active or Retiree) for the current plan year.
Other FormsMountaineer Flexible Benefits Benefit Coordinator Reference Manual
Mountaineer Flexible Benefits Demographic Change Form (Active Employees)Mountaineer Flexible Benefits Demographic Change Form (Retirees)
Personal Pay Summary Form
Sun Life Dental Claim Form
Humana EyeMed Claim Form