Benefit Services Forms and Documents
Employee Benefits Forms
Employee Leave Forms
Legal Notices and Certificates
- LTD-ORD Certificate pdf
- ACA Notice pdf
- CHIP Notice pdf
- HIPAA Rights pdf
- Required Legal Notices pdf
- STD Amendment pdf
Retirement Planning Forms
Current Retiree Forms
- Pre Medicare Benefits-At-A-Glance pdf
- Post Medicare Benefits-At-A-Glance pdf
- Silverscript Summary of Benefits pdf
- Retiree Summary Plan Description pdf
- CMS Notice of Creditable Coverage pdf
- HRA FAQ pdf
- Retiree ACH Form pdf
- Retiree Rates - Tier 1 pdf
- Retiree Rates - Tier 2 pdf
- Retiree Rates - Tier 3 pdf
- Retiree Rates - Tier 4 pdf
- Retiree Tier 1 Death Benefit Beneficiary Form pdf
- Retiree Tier 1 Death Benefit Summary pdf