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FSA Plan for UCC Ministries Medical Care Expense Claim Form
FSA Plan for UCC Ministries Dependent Care Claim Form
Medical Transportation Expense Certification Form 2021
FSA Plan for UCC Ministries Change in Status Election Form
FSA Plan for UCC Ministries Election Form and Compensation Reduction Agreement Form 2021
FSA Plan for UCC Ministries Election Not to Participate Form
FSA Plan for UCC Ministries Revocation of Benefit Election and Compensation Reduction Agreement Form
Certification of Domestic Partner as Dependent or Non-Dependent
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 Death Benefit Application
Optional Additional Death Benefit Designation of Beneficiary Form
Application for Ministerial Assistance
Higher Education Scholarships for Children of Disabled or Deceased Ministers
Herring Stark Memorial Funds Application
Ministerial Assistance Grants Brochure
Click here for documents and information related to NGLI applications
UCBMA Ministerial Assistance General Information
Personal and Financial Organizer
Medical Benefits (Non-Medicare) Enrollment
Application for Medical Benefits for Adult Children (Under Age 26)
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
Certification of Domestic Partner as Dependent or Non-Dependent
Annuity Plan Membership Application
Employee Retirement Contribution Agreement Form
Formerly the "TSA Salary Reduction Agreement"
Retirement Savings Account (RSA) Application
Rollover Contribution Account (RCA) Agreement Form
Annuity Plan UCC Beneficiary Designation Form
Designation of Beneficiary/120 Payments Form
Retirement Saving Account Beneficiary Designation Form
Allocation of Future Contributions and Fund Reallocation Form
Annuity Plan UCC Fund Reallocation Form
Withholding Certificate for Pension or Annuity Payments
Retirement Savings Account Withdrawal Application
Rollover Contribution Account Withdrawal Application
Request for Direct Rollover of Funds to the Pension Boards
Salary Report Form - Individual
Post-Retirement Pension Death Benefits Form
Pre-Retirement Death Benefits for Spouse Under Age 50 Form
Pre-Retirement Death Benefits for Spouse Over Age 50 Form
Brewster Allocation of Future Contributions
Brewster Annuity Plan Membership
Brewster Beneficiary Designation
Brewster Employee Retirement Contribution Agreement