Phone: 239-477-1000
Emergency: 911
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The Lee County Sheriff's Office employee & retiree benefits site contains information on: medical, dental, vision, contact numbers, and other important resources. At anytime we welcome you to contact the Benefits / Risk Management Unit for additional information at (239) 477-1089

Forms

Health Forms

        Medical Claim Form (PDF)

        Dental Claim Form  (PDF)

        Vision Claim Form  (PDF)

        CIGNA Home Delivery (PDF)

        Prescription Claim Form (PDF)

Star Care Forms

        New Patient Information Packet (PDF)

Life Insurance Forms 

         SYMETRA Beneficiary Change Form (PDF)

         Hartford Beneficiary Change Form  (PDF)

FRS Forms

         Active Members Only-Pension Beneficiary Change Form (PDF)

         Retired Members Only-Pension Beneficiary Change Form (PDF)

         Active & Retired Members - Investment Beneficiary Change Form (PDF)

Risk Management Forms

          FMLA Leave Request  (PDF)

          Vehicle/Vessel Loss Form (PDF) 

Misc.

          2014 W-4 (PDF)

          Line-of-Duty Death Information (PDF)