Benefits, Leaves, & Retirement
Forms for Active Employees

BENEFITS FORMS

To enroll in benefits or change your benefits:

  • BCPS Enrollment/Change Form (Eff. 1/1/17 - 12/31/17)
  • BCPS Enrollment/Change Form (Eff. 1/1/16 - 12/31/16)
    New hires must submit form within 60 days of your hire date.  Current employees must submit changes within 30 days of a qualifying event.
    All other changes must be submitted during the annual Open Enrollment period.

Medical:

Prescription:

Dental:

Vision:

Flexible Spending Account:

Life Insurance and PAI (Personal Accident Insurance): (Effective 09/01/09)

LEAVES FORMS 

To Apply for a Leave of Absence or a Conversion:

Additional forms for an HR approved leave (less than 90 days):

Additional forms for a Board approved leave (more than 90 days):

RETIREMENT FORMS

Maryland State Retirement Agency (MSRA):

Baltimore County Employees’ Retirement System (ERS):

Supplemental Retirement:

For Payroll forms such as direct deposit forms, W-4 tax withholding forms, and address/name change forms, please visit the Office of Payroll at: http://www.bcps.org/offices/payroll/

Publications
Benefits Enrollment Guide
(Eff. 1/1/17 - 12/31/17)
Benefits Enrollment Guide
(Eff. 1/1/16 - 12/31/13)
Retiree Benefits Guide
(Eff. 1/1/17 - 12/31/17)
Retiree Benefits Guide
(Eff. 1/1/16 - 12/31/16)
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