Open Enrollment Forms

Below are links to forms that need to be completed during Open Enrollment.
If you have questions, please contact the Benefits office at (318) 673-5420.

Benefits Change Request
Enroll in and make changes to medical, dental, vision plans.
Also use this form if you are unable to complete Open Enrollment via the E-Suite application.

Healthcare Pre-Tax Benefits Plan
Allows you to pay for medical or dental plans with "before-tax" dollars.

Affidavit of Spouse Healthcare Coverage
Certify that other medical coverage is not available to your spouse

Tobacco-Free Affidavit
Certify members covered by City of Shreveport plans are tobacco-free, understanding tobacco users are subject to a surcharge.

2022 Coverage Rates
View the new coverage rates for 2022

2022 Benefits Guide

2022 Benefits Guide