[Montgomery County, MD] FOP Retiree Fully Insured Vision Enrollment Form

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Upload Dependent Documentation if Enrolling NEW Dependents If your dependents are already covered under any other health plan, documentation is not required and you can skip this section.

Please upload the necessary required documentation (i.e. marriage and birth certificates). Click HERE for more information on required documentation.

If you have more than one child and need to provide multiple birth certificates, it is recommended that you combine all of the birth certificates into one document before attaching.

There is a 250MB limit on each attachment.

Official state marriage certificate (certified by appropriate state or county official) Click Here to Upload

State birth certificate Click Here to Upload

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Upload Dependent Documentation if Enrolling NEW Dependents If your dependents are already covered under any other health plan, documentation is not required and you can skip this section.

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