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Insurance Forms
Following are various forms you may download and submit to the Insurance Department. If you have any questions regarding these forms, please contact the Insurance department at 337-521-7066.

Change of Address Form
Use this form to change your name, address or telephone number.

BCBS Enrollment Form
Use this form to enroll in health insurance.

BCBS Health Insurance Change Form
Use this form to change your health insurance plan. Plan changes can only be made during Open
Enrollment or due to a Qualifying event.

BCBS Cancellation Form
Use this form to cancel health benefits with LPSS.

Waiver of Health Coverage Form
Use this form to voluntarily elect to decline the election of health insurance with LPSS. This form is
MANDATORY if you are not choosing to elect health coverage with LPSS.

HSA Change Form
Use this form to request a change in the amount you deduct from your check to be deposited into your HSA account.  You can change this deduction any time during the year.  


Life Insurance Forms   

Beneficiary Designation Form  - Use this form for your initial selection of your life insurance beneficiaries or to change your beneficiary designations.