Here are the forms you'll need to complete (as appropriate to your situation) when you enroll for Costco benefits:

• Accelerated Death Benefit (ADB) Claim Form
• ADB Instructions
• 401(k) Beneficiary Form – to add or change a beneficiary to the plan
• 401(k) Summary Plan Description – to learn more about how the 401(k) plan works
• Attending Physician Statement Form – to file for disability
• Beneficiary Designation - for Basic and Supplemental Life and AD&D
• Declaration of Domestic Partnership and Overview - to enroll a domestic partner and his or her children
  • Declaration of Termination of Domestic Partnership
• Declaration of Domestic Partnership and Overview – Puerto Rico - to enroll a domestic partner and his or her children
• Declaration of Health Care Coverage - for Vermont employees
• Declaration of Legal Guardianship - to enroll a child for whom you are a legal guardian
• Declaration of Plan Eligibility for Foster Child – Puerto Rico - for employees who reside in Puerto Rico only. To enroll your foster child(ren)
• Declaration of Plan Eligibility for Stepchild - to enroll stepchildren
  • Declaration of Termination of Eligibility for Stepchild
• Decline Coverage Acknowledgment - to decline medical coverage
• Employee Benefit Enrollment/Change Form - to choose or decline coverage and to enroll family members, name beneficiaries, elect Supplemental Life coverage, Supplemental AD&D coverage and participate in the DCAP
  • Employee Benefit Enrollment/Change Form - Hawaii
• Enrollment Self-Service Brochure - Instructions on how to make benefit selections and changes
• Highlight Brochure - to learn more about the benefits available to you as an employee - and how those benefits can work in your life
• Medicare Part D Notice – Information about your prescription drug coverage and Medicare
• Puerto Rico Medicare Part D Notice
• Pharmacy Precertification Form
• Reimbursement Accounts Enrollment Form - to indicate how much you will contribute to the Dependent Care Reimbursement Account
• Summary Plan Description - copy of your plan document for the Costco Employee Benefits Program
• Summary Plan Description - Puerto Rico
• Supplemental Life & AD&D Insurance Application – Puerto Rico - to elect an amount of Supplemental Life insurance
• Supplemental Life Application - to elect an amount of Supplemental Life insurance
• Work Restrictions Form

Need to file a claim for reimbursement?

• Dental Claim Form
• Dependent Care Reimbursement Account Claim Form
• Direct Deposit Form
• Health Care Reimbursement Account Claim Form
• Health Care Reimbursement Account Medical Necessity for Weight Loss Form
• Health Care Reimbursement Account Orthodontia Claim Form
• Hearing Aid Claim Form
• Medical Claim Form
• Over-the-Counter Product Reimbursement Account Claim Form
• Prescription Drug Claim Form
• Vision Exam Claim Form

All of the forms and booklets listed above are available for viewing and the option to print when you click on the corresponding link. If you would like a form or booklet sent to you, contact the Employee Benefits Department at 1-800-284-4882 or benefits@costco.com.