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Forms

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General Forms 

Add/Remove Dependent(s) To/From Your Health Plans

You will need to complete a Health Benefits Change form if you wish to add/remove dependent(s) from your health plans. Supporting documentation will be required. A completed Health Benefits change form must be received by Health and Wellness within 30 days of a permitting event, unless otherwise noted in the Health Benefits Eligibility Policy.

Change Beneficiary on the County-Paid Life Insurance

You will need to complete a new Beneficiary form, if you wish to change your beneficiary on the County-Paid Life Insurance. Kern County will always use the most recent dated Life Insurance Beneficiary from on file.

Submit a Reimbursement from your Flexible Spending Account

You will need to complete a Flexible Spending Account Claim form, if you wish to submit a reimbursement to your Medical or Dependent Care Flexible Spending Account.

You can also submit claims online: Administrative Solutions Member Portal


Kern Legacy Forms


Retiree Forms

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