skip to:
lanlbar
|
menubar
|
toolbar
|
links
|
content
Lab Home
|
Phone
ABOUT LANL
Contacts
Event Calendar
Maps
Organization
Phonebook
Policy Center
Emergency
NEWS
LIBRARY
JOBS
Life @ LANL
>
Benefits
Benefits Home
Health Insurance
Other Insurance
Retirement Planning
Tax Savings
Awards
Time Off
Perks
Retiree Benefits
Plan Reports
Contacts
email
:
benefits@lanl.gov
phone
: 505-667-1806
877-667-1806
fax
: 505-665-2156
address
: TA-3
Otowi Building 261
2nd Floor
Mail Stop P280
hours
: 8am-5pm
Tues. 10am-5pm
Frequently Used Phone Numbers
Benefits
» Forms and Publications
Forms and Publications
Awards
COBRA Information Sites and Forms
Domestic Partnership
Family and Medical Leave
Health and Insurance
Miscellaneous Forms
Payroll
Awards
Contract Worker Award Nomination Form (pdf)
Cover Sheet for Individual Distinguished Performance Award Nomination (1831) (pdf)
Cover Sheet for Large Team Distinguished Performance Award Nomination (1833) (pdf)
Cover Sheet for Small Team Distinguished Performance Award Nomination (1832) (pdf)
Employee Referral Incentive Authorization (1749) (pdf)
Justification for Hire-On Incentive (1748) (pdf)
Los Alamos Awards Program (LAAP) (1794) (pdf)
Spot Nomination Form (1795) (pdf)
Service Award Funding Request (1762) (pdf)
COBRA Information Sites and Forms:
Health Care Benefits Under COBRA (pdf)
Cobra Consolidated Omnibus Budget Reconciliation
Departpartment of Labor - COBRA
Domestic Partnership
Declaration of Domestic Partnership (1925a) (pdf)
Domestic Partner: Termination of (1925c) (pdf)
Family and Medical Leave
Certification of Health Care Provider (1786) (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)
Health and Insurance
Beneficiary Designation/Change Form (1938) (pdf)
Blue Cross of California website (pdf)
Core Insurance Enrollment Form (1760) (pdf)
Delta Dental Claim Form (pdf)
Dependent Care/HCRA Enrollment Agreement (1922) (pdf)
Dependent Care/HCRA/TIPS Change or Cancellation Agreement (1924) (pdf)
For 2007 claims
,
Dependent Care Reimbursement Account Form (pdf)
For 2007 claims
,
HealthCare Reimbursement Account Form (pdf)
Full-Level Insurance Enrollment Form (1751a) (pdf)
Mid-Level Enrollment Form (pdf)
MedCo Pharmacy Mail Order Form (pdf)
Medco Prescription Drug Reimbursement Claim Form (pdf)
UHC Select EPO Claim Form (pdf)
UHC International Claim Form (pdf)
UHC Flexible Spending Account Claim Form (pdf)
Miscellaneous Forms
Housing Request Form (1814) (pdf)
IRS Forms & Publications
LANL Employment/Affiliation Confirmation (1848) (pdf)
Request for Community Service Time (704) (pdf)
Request for Reimbursement from Employee Morale Fund (1763) (pdf)
Social Security Forms
Tuition Waiver Form (pdf)
Payroll
Payroll Forms
UHC On-Site Representative
Benefits Forms
Benefits Program Summaries
Benefits Plans Participation Terms and Conditions
Fidelity Investments
Human Resources Home
My UHC Web Site
UC's Benefits & Policies
Los Alamos National Laboratory
• Est 1943