County of Orange Benefits Forms

PPO Health Plans

• Medical Claim Form

Health Care & Dependent Care Reimbursement Account (HCRA & DCRA)

• HCRA Claim Form
• DCRA Claim Form

Management & Attorney Benefit Plans

• Dental Claim Form
• Disability Salary Continuance Claim Packet Instructions
• W4 (MUST be submitted with Salary Continuance Form)

Leave of Absence Brochures

• Parenthood Leave Brochure
• Leave of Absence Brochure