Office of Group Benefits

State of Louisiana

Official Website: https://www.doa.la.gov/doa/ogb/

Forms & Documents

Browse all Office of Group Benefits government forms

1 - 20 of 62 forms

Form Title Topics
2024 GB-02 Flexible Spending Arrangement Enrollment\Stop Form
2025 Prudential Enrollment and Beneficiary Designation Form
2026 GB-02 Flexible Spending Arrangement Enrollment Form
2026 GB-02 Flexible Spending Arrangement Enrollment\Stop Form
2027 Ochsner Health Medical Exemption Form
2027 Ochsner Health Primary Care Provider Form
Accelerated Benefit Option Claim Form
Administration Manual
Application for Conversion of Group Life Insurance
Blue Cross Medical Records Request Form
Certificate of Coverage
Converting Group Term Life Insurance to Individual Insurance
Evidence of Insurability Form (EOI)
Evidence of Insurability Form (EOI) Short Form (Only Available during Annual Enrollment)
GB-01 Enrollment/Change Form
GB-01 Enrollment/Change Form
GB-03 Address or Name Change Form
GB-04 Automatic Bill Payment Authorization Form
GB-05 PHI Authorization Form
GB-06 Request for Continuation of Coverage for Incapacitated Dependent Child

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