Chapman University - HR - Benefits Enrollment - Provider Forms and Documents

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Provider Forms and Documents

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BLUE CROSS OF CALIFORNIA:

Blue Cross Prudent Buyer (PPO Plan) Summary of Benefits

Blue Cross CaliforniaCare (HMO Plan) Summary of Benefits

Blue Cross Out of Area (BC PPO) Summary of Benefits

Blue Cross Prescription Drug Benefits

Blue Cross PPO - HMO Enrollment Booklet

Blue Cross Enrollment Form

Blue Cross Change Form

Blue Cross Guest Membership Application

KAISER:

2008

Kaiser Summary of Benefits

Kaiser Change Form

Kaiser Student Certification Form

Kaiser HIPAA Authorization

DELTA DENTAL (PPO):

2008

Delta Dental Dual Choice Enrollment Form

Delta Dental PPO - HMO Summaries and Side by Side Comparison

Delta Dental PPO - Evidence of Coverage and Disclosure Form

DELTACARE (HMO):

2008

Delta Dental Dual Choice Enrollment Form

Delta Dental PPO - HMO Summaries and Side by Side Comparison

Delta Care HMO Summary of Benefits

VISION SERVICE PLAN (VSP):

VSP Summary of Benefits

VSP Evidence of Coverage and Disclosure Form

FLEX-PLAN SERVICES – FLEXIBLE SPENDING ACCOUNTS (FSA):

2008

Flexible Spending Account Enrollment Kit

Flexible Spending Account Enrollment Form

Flexible Spending Account Claim Form

FLEX-PLAN SERVICES – TRANSPORTATION REIMBURSEMENT ACCOUNTS:

2008

Transportation Account Enrollment Kit

Transportation Plans Option Sheet

Transportation Account Enrollment Form

Transportation Account Claim Form

DISABILITY INSURANCE:

Short Term Disability - Insurance Certificate

Short Term Disability - Summary of Benefits

Long Term Disability - Insurance Certificate

Long Term Disability - Summary of Benefits

CHAPMAN-Paid LIFE/AD&D INSURANCE:

Group Term Life/AD&D Insurance Certificate

Life/AD&D Summary of Benefits

MEDEX Travel Assist Brochure 2006

MEDEX Group Certificate 2006

PRUDENTIAL SUPPLEMENTAL LIFE/AD&D INSURANCE:

Supplemental Life Insurance Application

Supplemental AD&D Insurance Application

Supplemental Life Insurance Certificate

Supplemental Life Insurance Name/Address Change Form

HEALTH AND WELLNESS PROGRAMS:

OC Vital Imaging - Heart and Lung Scans

EAP - PACIFICARE BEHAVIORAL HEALTH:

Employee Assistance Program Flyer

Employee Assistance Program Brochure

Wellness Monthly - 2008

April - Living Within Your Means: Simple Strategies for Getting Ahead

May - Are We There Yet? Stress-Free Family Vacations

June - Family Feud: Strategies for Handling Sibling Rivalry

SIGNATURE LEGAL CARE INSURANCE:

Signature Legal Care Brochure

Signature Legal Care Enrollment Form