Browse the list below to locate the Document or Form you are looking for.
Metlife Dental Expense Claim
Annual Physical & Tobacco Attestation Form With Instructions – 2021Annual Physical & Tobacco Attestation Form With Instructions – 2021 (Electronic Fillable)
Health Care Enrollment Change FormHealth Care Enrollment Change Form (Electronic Fillable)
Working Spouse Employer Verification FormWorking Spouse Employer Verification Form (Electronic Fillable)
Health Care Waiver Form [Word Document]Health Care Waiver Form [PDF File]
Health Enrollment Form – Medicare 2019 [Word Document]Health Enrollment Form – Medicare 2019 [PDF File]
Medical Mutual Claim FormAnnual Physical & Tobacco Attestation Form With Instructions – 2020
HSA Payroll Deduction Authorization
UNUM Long Term Care
CVS Caremark Mail Service Form
Dental Plans
Health Rates July 2020 – June 2021
MMO PPO HSA 2021/2022 Summary of Benefits and CoverageMMO PPO 2021/2022 Summary of Benefits and CoverageSkyCare EPO 2021/2022 Summary of Benefits and CoverageMedFlex EPO 2021/2022 Summary of Benefits and Coverage
MMO PPO/HSA Plan 2020/2021 Certificate (Clergy)MMO PPO/HSA Plan 2020/2021 Certificate (Lay Deacons)MMO PPO/HSA Plan 2020/2021 Certificate (Religious)
MMO PPO Plan 2020/2021 Certificate (Clergy)MMO PPO Plan 2020/2021 Certificate (Lay Deacons)MMO PPO Plan 2020/2021 Certificate (Religious)
SkyCare EPO Plan 2020/2021 Certificate (Clergy)SkyCare EPO Plan 2020/2021 Certificate (Lay Deacons)SkyCare EPO Plan 2020/2021 Certificate (Religious)
MedFlex EPO Plan 2020/2021 Certificate (Clergy)MedFlex EPO Plan 2020/2021 Certificate (Lay Deacons)MedFlex EPO Plan 2020/2021 Certificate (Religious)
Skyway Network Locations for SkyCare EPO Plan
MedFlex Hospital Locations for MMO MedFlex EPO Plan
Labs that Charge Less than Maximum CostLab Services with Maximum Allowable Cost
HSA Disclosure Statement And Custodial Account AgreementImportant Information Regarding The Interaction Of Flexible Spending And Health Savings AccountsPNC HSA Deposit Account Disclosure
IRS Publication 502-2018IRS Publication 969-2018
2020 Benefits Newsletter2019 Benefits Newsletter2018 Benefits Newsletter
CVS Caremark MMO Plans 2019-2020CVS Caremark MMO Plans 2018-2019
Performance Drug List (Rev 04-2020)Preventive Drug List (Rev 02-2020)
CHALTA VisionVision Service Plan
CHIP Notice
FAQs 2020FAQs 2019
Healthcare Handbook 2020-2021Healthcare Handbook 2019-2020Healthcare Handbook 2018-2019
Notice of Privacy Practices for Medical Information
2020 Medicare Advantage Overview2020 Medicare Advantage Preferred Pharmacy Network2020 Medicare Advantage Provider Directory and Formulary Assistance2020 Medicare Advantage Summary of Benefits
2019 MedMutual-Advantage PPO Plan Benefit Highlights2020 Medicare Advantage Provider Directory and Formulary Assistance2020 Medicare Advantage Preferred Pharmacy NetworkMedMutual Advantage PPO Plan SilverSneakers2020 Medicare Advantage Summary of Benefits
Evidence of Coverage – Clergy 2020Evidence of Coverage – Non-Clergy 2020Evidence of Coverage Requests – Clergy 2020Evidence of Coverage Requests – Non-Clergy 2020Annual Notice of Change – Clergy 2020Annual Notice of Change – Non-Clergy 2020
Evidence of Coverage – Clergy 2019Evidence of Coverage – Non-Clergy 2019Evidence of Coverage Requests – Clergy 2019Evidence of Coverage Requests – Non-Clergy 2019Annual Notice of Change – Clergy 2019Annual Notice of Change – Non-Clergy 2019
