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Dental Benefits Plan Enrollment Application Only - For enrollment period of October 1-31 of every Plan Year
FSA Plan for UCC Ministries Medical Care Expense Claim Form
Qualifying Medical Care Expenses Worksheet
Domestic Partnership Statement of Financial Interdependence Form
Life Insurance (LIDI) Designation of Beneficiary Form
Life Insurance and Disability Income (LIDI) Benefit Plan Enrollment Application
Life Insurance and Disability Income (LIDI) MetLife Enrollment Change Form
Optional & Additional Life Insurance Forms
Optional Additional Death Benefit Designation of Beneficiary Form
Statement of Dependent Eligibility Beyond Limiting Age in Plan Due to Mental or Physical Handicap
Medical (Non-Medicare) and Dental Benefits Enrollment
Medicare Advantage Plan and Dental Benefits Enrollment Form
Small Employer Exemption (SEE) Form
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.
Domestic Partnership Statement of Financial Interdependence Form
Annuity Plan Membership and Other Benefits Form
Online Employee Retirement Contribution Agreement Form "TSA"
For current Members
Employee Retirement Contribution Agreement Form "TSA"
For new Members
Retirement Savings Account (RSA) Application
Rollover Contribution Account (RCA) Agreement Form
Annuity Plan UCC Beneficiary Designation Form
Allocation of Future Contributions and Fund Reallocation Form
Health Benefits Automatic Credit Reduction Form
Withholding Certificate for Pension or Annuity Payments
Retirement Savings Account (RSA) and Rollover Contribution Account (RCA) Withdrawal Application
Request for Direct Rollover of Funds to the Pension Boards
Employer Compensation Change Form (formerly Salary Report Form)
Termination of Benefits/Employment
Beneficiary Acknowledgement Form
Post-Retirement Pension Death Benefits Form
Pre-Retirement Death Benefits for Spouse Form
Pre-Retirement Death Benefits for Non-Spouse Form
Brewster Allocation of Future Contributions and Fund Reallocation Form
Brewster Annuity Plan Membership
Brewster Beneficiary Designation
Brewster Employee Retirement Contribution Agreement
Brewster Fund Reallocation Form
Brewster Hardship Withdrawal Request
Brewster In-Service Withdrawal Request
Brewster Rollover Agreement (RCA) Form
Brewster Rollover Contribution Account (RCA) Withdrawal Form
CHAMPS Homes Allocation of Future and Fund Allocations Form
CHAMPS Homes Annuity Plan Membership Application
CHAMPS Homes Annuity Plan Member Acknowledgement Form
CHAMPS Homes Annuity Plan Beneficiary Acknowledgement Form
CHAMPS Homes Beneficiary Designation
CHAMPS Homes Employee Retirement Contribution Form
MSAG New Annuity Plan Membership Application
MSAG Annuity Plan Member Acknowledgement Form
MSAG Annuity Plan Beneficiary Acknowledgement Form
MSAG Allocation of Future Contributions and Fund Reallocation Form
RYDER Acuerdo de Aportaciones Personales del Empleado
RYDER Formulario de Asignación de Contribuciones Futuras y Reasignación de Fondos
RYDER - Formulario de Cambio de Compensación (Ryder – Compensation Change)
RYDER Formulario de Designacion de Beneficiarios
RYDER Plan de Anualidad Formulario de Inscripción
RYDER Reconocimiento del Beneficiario
RYDER Reconocimiento de Miembros
RYDER Healthcare Integrated Service - Formulario de Cambio de Compensación (Compensation Change)
St. Paul's Allocation of Future Contributions Form
St. Paul's Beneficiary Designation Form
St. Paul's Employee Retirement Contribution Agreement (ERCA) Form