Important Documents/Forms


Medical Plan Documents

Benefits Changes FAQ
2021-2022 Benefits Guide
2021-2022 Benefit Guide (Spanish)
RX Copay Armor
Flexible Benefits Plan Summary Plan Description
2021 Highmark Blue Shield Preventive Schedule
New Enrollee Wellness Incentive Flyer
ADA Wellness Notice
$1000 PPO Summary of Benefits and Coverage
Medical $1000 PPO Plan
$1500 PPO Summary of Benefits and Coverage
Medical $1500 PPO Plan
$2000 PPO Summary of Benefits and Coverage
Medical $2000 PPO plan
Tobacco Cessation Programs
Mail Order RX Flyer
Electronic Consent Flyer


Dental Plan Documents

Dental High Plan
Dental Low Plan


Vision Plan Documents

Vision Member Handbook


Critical Illness Plan Documents

Critical Illness Class 1 Certificate of Insurance
Critical Illness Class 2 Certificate of Insurance
Critical Illness Class 3 Certificate of Insurance
Critical Illness Class 4 Certificate of Insurance


Accident Insurance Plan Documents

Accident Flyer
Group Accident Full-Time Certificate of Insurance
Group Accident Part-Time Certificate of Insurance


Life Insurance Plan Documents

Life Insurance Beneficiary Form
Evidence of Insurability Form
Evidence of Insurability - online instructions


ID Theft Protection

Allstate ID Protection Overview (flyer)
Allstate ID Protection Features
Allstate ID Protection FAQs


401(K) Plan Documents

401(K) Enrollment Guide 2021
401(K) Summary Plan Description
401(K) Plan Amendment
401k Brainshark Video


EAPs

EAP Flyer
EAP Brochure


Hospital Indemnity

Group Hospital Part-Time Certificate of Insurance
Group Hospital Full-Time Certificate of Insurance


Flexible Spending/Dependent Care Accounts

Ameriflex Mobile App Guide
Claim Form
Claims Form (Spanish)
Employee Request for Service form
Substantiation Request
Substantiation Request_Spanish
DCAP Grace Period Extension
FSA Grace Period Extension
FSA Over-the-Counter


Notices

Medicare Part D Creditable Coverage Disclosure Notice
HIPAA Notice of Privacy Practices
Employer Children's Health Insurance (CHIP)
Lincoln Financial Group Privacy Notice
Benefits Summary Annual Report 2019
401(k) Summary Annual Report 2019
UNUM Claims Flyer