Forms

Medical, Dental, and Vision Forms

New employees enroll in PWCS medical, dental, and vision plans online through the Employee Self Service (ESS) system.

ESS

For PWCS medical, dental, and vision plan mid-year change forms and premium information, visit the PWCS Benefits Launchpad site.

Medical/Dental/Vision Claim Forms

• For Anthem out-of-network claim forms, log in to your account on the Anthem website.
• For Delta Dental out-of-network claim forms, log in to your account on the Delta Dental website.
• For Vision Service Plan (VSP) out-of-network claim forms, log in to your account on the VSP website.

Flexible Benefit Program Forms

Visit the PWCS Intranet webpage for Flexible Spending Enrollment forms

For Flexible Spending Claim forms or online claims submission, log into your account at the P&A Group website.

Virginia Retirement System (VRS) Forms

PWCS Forms

• Payroll Forms - (direct deposit, tax withholding, etc.)
• HR Forms

Lincoln Financial Group Forms

Changes to your 403(b) contributions and beneficiaries are now done either online or by contacting Lincoln Financial directly.

• Lincoln Financial webpage
• Lincoln Retirement Consultant Contact Information
• Lincoln Financial Customer Service 1-800-234-3500

Time & Leave Forms

For PWCS Leave forms, visit the PWCS Benefits Intranet webpage.

Standard Long Term Disability Forms

• Standard LTD Application (Non-VRS Hybrid Members) (PDF)
• Standard LTD Electronic Medical History Statement (non-VRS hybrid members)

Tuition Reimbursement Forms

Please note: Tuition reimbursement requests must be submitted as soon after registration for approval. We do not accept initial requests for reimbursement once the class is over.

Tuition Reimbursement requests must be made electronically using the PWCS Records site. Click on Available Forms from the left navigation, select the correct form and follow instructions for submission of your request.