Enrollment Forms

Benefits-at-a-Glance

2019 Annual Enrollment Guide

2019 Annual Retiree Enrollment Guide

Dependent Coverage Requirements (new)

2019 Benefit Costs (new)

2019 Retiree Benefit Costs (new)

Health Benefits Contact Information

 

Medical Benefits

Plan Comparison

Aetna Choice POS II Plan Document

Aetna Choice POS II Plan Summary of Benefits and Coverage

Aetna Health Fund Plan Document

Aetna Health Fund Plan Summary of Benefits and Coverage

Hearing Aid Benefit

Medical Reward Credit form for Vision and Dental

Preventive Care Coverage

Premium Reduction Program

 

Pharmacy Benefits

Prescription Benefit Description (new)

Maintenance Medication Frequently Asked Questions

 

Dental Benefits

PPO Plan Document

PPO Schedule of Benefits

Dental Plan Comparison (new)

PPO Plan Summary of Benefits

DMO Plan Summary of Benefits

Dental Card Information

Dental Claim Form – PPO

Dental Claim Form – DMO

2019 Benefit Costs (new)

 

Vision Benefits

Advantica Plan Summary of Benefits

Advantica Claim Form

2019 Benefit Costs (new)

 

Flexible Spending Accounts

Why Enroll in an FSA?

FSA Expense Claim Form

 

Life Insurance

Sun Life Insurance Plan Document-Life and Long Term Disability

Sun Life Evidence of Insurability Form

Allstate Universal Life Brochure

Allstate Universal Life Rate Sheet

Allstate Universal Life Enrollment Form

2019 Benefit Costs (new)

 

Disability

Sun Life Insurance Plan Document-Short Term Disability

Sun Life Insurance Plan Document-Life and Long Term Disability

2019 Benefit Costs (new)

 

Accident and Cancer Insurance

Allstate Accident Plan

Allstate Cancer Plan

Allstate Accident and Cancer Enrollment/Evidence of Insurability Form

Allstate Cancer Wellness Claim Form

Accident Claim Form

Cancer Claim Form

2019 Benefit Costs (new)

 

Long Term Care Insurance

UNUM Long Term Care Package – Non-management Employees

UNUM Long Term Care Package – Managers

UNUM Long Term Care Package – Directors and Senior Managers

UNUM Long Term Care Package – Executive Management

2019 Benefit Costs (new)

 

Identity Theft Protection

InfoArmor Identity Theft Protection

2019 Benefit Costs (new)

 

Legal Services

Preferred Legal Services

2019 Benefit Costs(new)

Wellness

Premium Reduction Program

 

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