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) 673-5151.


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.