Forms

National Fraternal Order of Police Retirement Health Savings Plan

• NFOP RHS Plan Member Enrollment Form
  Use this form to enroll in the NFOP RHS Plan or to notify ICMA-RC if you change employment. If you are enrolling for the first time, ask your lodge about timing of your annual enrollment window.
  
• NFOP RHS Fund Options Sheet
  A list of funds available for investment in the National Fraternal Order of Police Retirement Health Savings Plan, including short descriptions and ICMA-RC fund codes.
  
• VantageCare RHS Pre-Tax Election Form
  Use this form to designate the amount of pre-tax contribution from your pay you wish to make each payroll period to your RHS account.
  
• VantageCare RHS Accrued Leave Election Form
  Use this form to designate the contribution amount from your pay you wish to make each payroll period to your RHS account. Use this form to designate the amount of accrued leave you wish to have contributed to your RHS account on a pre-tax basis.
  
• NFOP RHS Staff Plan Benefit Eligibility Form
  Complete this form once you become eligible to receive benefits from the NFOP RHS Plan.
  
• NFOP RHS Plan Member Information Change Form
  Use this form to enroll in the NFOP RHS Plan or to notify ICMA-RC if you change employment.
  
• NFOP RHS Member Plan Benefits Reimbursement Request Form
  Use this form to request reimbursement for qualifying medical expenses once you are eligible.
  
• NFOP RHS Member Plan Decedent Information Form
  This form may be used to report the death of a participant. It may also be used to report the death of a spouse or dependent who had previously received an account transfer.
  
• NFOP RHS Personal Information Form For Survivors
  Survivors of a deceased plan participant may use this form to designate beneficiaries and to make changes in their RHS account information.
  
• NFOP Vantagecare Retirement Health Savings Plan Member Questions and Answers
  NFOP RHS plan member frequently asked questions.
  
• NFOP RHS Introduction Letter
  An introduction letter to the NFOP RHS plan.
  

Blue Line 457 Plan

• NFOP 457 Blue Line Introduction Letter
  An introduction letter to NFOP 457 Blue Line plan.
  
• FOP Blue Line 457 Plan Member Questions and Answers
  Blue Line 457 plan member frequently asked questions
  
• NFOP RHS/457 Blue Line Introduction Letter
  An introduction letter to RHS/NFOP 457 Blue Line plan.
  
• Blue Line 457 Account Transfer Form
  Use this formm to transfer an existing 457 account to your Blue Line 457 Plan account.
  
• Blue LIne 457 Plan Deferral Election Form
  FOP members use this form to make changes in the amount of your deferral to your Blue Line 457 Plan.
  
• Blue Line 457 Enrollment Form
  Use this form to enroll in the Blue Line 457 Plan
  
• NFO Blue Line 457 Deferred Compensation Plan and Trust
  NFO Blue Line 457 Deferred Compensation Plan and Trust
  
• NFOP Fund Options - G
  Fund Options - G
  
• NFOP Fund Options - R
  Fund Options - R