City of Scottsdale

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 > Home Page > Human Resources > Benefits Information > Employee Benefit Forms

Employee Benefit Forms

• Enrollment
  • Cigna MDLive Registration
  • Dependent Verification Form
  • Domestic Partner Affidavit
• Flexible Spending
  • ASI Flexible Spending Claim Form
  • ASIClaimForm
  • DirectDepositASIform
  • FSA Debit Card Application
  • FSA Worksheet
• Health Claims
  • Cigna Prescription Order Form
  • Wellness Screening Form
• HIPAA
  • HIPAA Privacy Notice
  • HIPAAAmendPHI
  • HIPAAAuthorization
  • HIPAAComplaintForm
  • HIPAAConfidentialTransmission
  • HIPAARequestAccountingPHIdisclosures
  • HIPAARequestInspectCopyPHI
  • HIPAARequestRestrictionsUseDisclosure
  • HIPAARevocationAuthorization
• Leave
  • Emergency Paid Sick Leave Request Form
  • FMLA Rights and Responsibilities
  • LeaveOfAbsenceNotification
  • ReturnToWork
• Life Insurance
  • Beneficiary Change Form for Life and Vol Life
  • NameChange
  • Voluntary Life Insurance Change Form
• Retirement
  • ASRS Presidential Callup
  • ASRS Return To Work
  • PSPRS Beneficiary Change Form

Contact Information

City of Scottsdale - Human Resources
9191 E. San Salvador Drive
Scottsdale, AZ 85258
Office Map 

P: 480-312-7600
Email: hrbenefitsemail@scottsdaleaz.gov

Member Services Toll-Free Number: 
P: 1-800-244-6224 (available 24 hours a day)
www.cigna.com

Benefit Links

Find a Doctor  Frequently Asked Questions Benefit Forms Holiday, Vacation & Medical HIPAA Privacy Notice

Medical Benefits

Cigna OAP In-Network Cigna LocalPlus Cigna OAP Cigna OAP + HSA HSA Information Domestic Partner Information Retirees & Cobra Participant

Dental Benefits

Cigna DHMO Cigna DPPO

Other Benefits and Services

Vision Flexible Spending Account Life Insurance Disability Insurance Deferred Compensation Tuition Reimbursement ASRS & PSPRS EAP, Behavioral Health & Substance Abuse