BENEFIT FORMS & DOCUMENTS

The following information on the group benefits was created to provide information about your benefit plans. They are not legal documents. In the event of a question or dispute, the terms, and entitlements of the plan documents will prevail. Click on Link or copy and paste to read.

SHORT TERM DISABILITY PROGRAM

Application for Coverage

22-054-300

DENTAL CARE PLAN

Application for Coverage

Application for coverage

Claim Form

dental_claim-e

Dependent Information Form

dependent_info-e

HEALTH CARE PLAN

VISION & HEARING PLAN

Extended Health Care Application for Coverage

ehcp_application_form-ef

Claim Form

CLAIM FORM – 51391-51392-e

List of Covered Drugs

List of Covered drugs and drug exception form link:-

Facts_covered_drug_list_all_employees_e

Claim Form - GM and above

m635d(51390)-e

Request for Drug Exception form/ List of Covered Drugs

Request for Drug Exception Form – List of Covered Drugs

Request for Coverage Airway Pressure Machine Assessment Form

Form_Request_for_coverage_for_positive_airway_pressure_machine_assessment_form_e

Declaration of Full Time Studies for Over Age dependent Students

declaration_fulltime_studies-e

Dependent Information

1. dependent_info-e