Browse the list below to locate the Document or Form you are looking for.
Metlife Dental Expense Claim
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 Form
HSA Payroll Deduction Authorization
UNUM Long Term Care
CVS Caremark Mail Service Form
Annual Physical & Tobacco Attestation Form With Instructions – 2022
High Plan Certificate
Standard Plan Certificate
Value Plan Certificate
Health Rates July 2020 – June 2021
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)
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
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 502-2020IRS Publication 969-2020
2021 Benefits Newsletter2020 Benefits Newsletter2019 Benefits Newsletter2018 Benefits Newsletter
CVS Caremark MMO Plans 2021-2022
HDHP HSA Preventive Drug List
Preferred Drug List
CHALTA VisionVision Service Plan
CHIP Notice
FAQS 2021FAQs 2020FAQs 2019
Healthcare Handbook 2021-2022Healthcare Handbook 2020-2021Healthcare Handbook 2019-2020Healthcare Handbook 2018-2019
Notice of Privacy Practices for Medical Information
2022 Medicare Advantage Directory Formulary Evidence of Coverage Requests
2022 Medicare Advantage Evidence of Coverage Religious Lay Deacons
2022 Medicare Advantage Annual Notice of Changes Religious Lay Deacons
2022 Medicare Advantage Evidence of Coverage Priests
2022 Medicare Advantage Annual Notice of Changes Priests
