Dental Benefits Plan Enrollment Application Only - For enrollment period of October 1-31 of every Plan Year
Annuity Plan Membership and Other Benefits Form - For enrollment in the dental plan or other benefit plans outside of open enrollment
FSA Plan for UCC Ministries Election Form and Compensation Reduction Agreement Form 2022 - For enrollment period of November 1, 2021 – December 27, 2021
Annuity Plan Membership and Other Benefits Form – For enrollment in the FSA plan or other benefit plans outside of open enrollment
To obtain a member submitted claim form or international claim form, please visit the Highmark website at www.highmarkbcbs.com or contact customer service at 866.763.9471 for assistance.
To obtain a pharmacy reimbursement form, please login to your account at www.express-scripts.com or contact customer service at 800.939.3781 for assistance.
Employee Retirement Contribution Agreement Form
Formerly the "TSA Salary Reduction Agreement"
Employer Compensation Change Form (formerly Salary Report Form)