ADVENTIST RETIREMENT
Alternative Beneficiary Designation Form
AIG Assurance Letter
Broadcast Pre-Retirement
Salary Reduction Agreement & Beneficiary Designation Form
AFLAC FORMS
Claim Forms: mail ATTN: Claims Dept; 1932 Wynnton Rd, Columbus, GA 31999-7251 or fax to 877-442-3522
Accident
Cancer
Continuing Disability
Initial Disability
Sickness
Specified Health Event
Flexone - Flexible Spending Account (FSA)
Flexone Request for Reimbursement for Medical and/or Dependant Care FSA
Direct Deposit Option
Salary Redirection Agreement
Policies
Accident Application
Accident Brochure
Accident Policy Price
Cancer Application
Cancer Brochure Level 1
Cancer Brochure Level 3
Cancer Level 1 and 3 Price
Short Term Disability Application
Short Term Disability Brochure
Short Term Disability < 39K Price
Short Term Disability > than 39K Price
Specified Health Application
Specified Health Brochure
Specified Health Price
Wellness Claim Forms:
Accident
Cancer
Hospital Indemnity
EMPLOYMENT
Application, Non-Education
Application, Education (Teachers and Principals)
Automobile Insurance Assistance Policy
Background Check Authorization for Employment
Employment Eligibility Verification and Instructions (I9)
Employee's Withholding Allowance Certificate (W4)
New Employee Data Collection
Pastor Travel Request (this form is to be submitted to the President's Office for processing)
Personnel Action Request (P.A.R.)
Service Record Request
Travel and Expense Report
Vacation Application (Exempt Employees)
AMERICAN SPECIALTY HEALTH NETWORK (ASHN) (Chiropractic Care)
Enrollment Application
FITNESS FOR LIFE
Activity Log
Aerobic Mile Conversion Chart
Employee Wellness Participation Plan and Application
HARTFORD
Accidental Death and Dismemberment (AD&D)
Enrollment Application
AD&D Highlights Sheet
Enrollment Card for Conversion
Basic Life Insurance
Basic Life Worksheet
Beneficiary Designation
IRS Rate Chart
Life Insurance Waiver
Supplemental Life
Application for Portability of Group Life Insurance Benefits
Enrollment Application
Life Conversations
Life Highlights Sheet
Notice of Conversion Privileges
Personal Health Application
Retiree Life Insurance Enrollment
HCAP (Health Care Assistance Plan)
Enrollment Application
Opt Out
Reimbursement Request
PPO Providers
Schedule of Benefits
Spouse Eligibility and Dependent Eligibility Worksheet
Spouse Eligibility, Determination by Zone
Student Certification Forms
Dependent Child Intention to Return to Full-time Educational Status
Dependent Child Medical Condition
Dependent Child Volunteer Service
Full-time Student Verification Form for Dependent Child
KAISER - Medical and Mental Health Insurance
Enrollment Application
Change Form
PACIFICARE POS - Medical and Mental Health Insurance
Enrollment Application
Change Form
VALIC - See ADVENTIST REITREMENT listed above
WORKERS COMPENSATION
Employer's Report Occupational Injry or Illness - 5020
Employee's Claim for Workers' Compensation Benefits - DWC-1