Forms

NEW for 2019!

Beneficiary Designation form

Davis Vision Claim form

Cigna [accident, supplemental life insurance, long term disability]

• Accidental Injury: How to Submit a Claim
• Accidental Injury Claim Form
• Benficiary Designation Form
• Long Term Disability: How to Submit a Claim
• Long Term Disability Claim Options
• Long Term Disability Claim Form

Dependent Affidavits [for dependents on your plan]

• Affidavit of Marriage
• Domestic Partner Packet

Health Savings Account [for High Deductible Plan]

• Salary Reduction Agreement

Health and Wellness

• Credit or Case Management Non Utilization of Service Fee Accommodation Application
• Waiver/Accommodation Form

HIPAA Release

• IBC Authorization for Disclosure of Health Information
• Health Advocate Authorization form

Retirement Plan [for voluntary contributions]

• Salary Reduction Agreement
• Salary Reduction Catch Up

Spouse Surcharge [if employed spouse on your plan]

• Spouse Surcharge Agreement