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HUMAN RESOURCES > Benefits > Provider Forms and Documents

Provider Forms and Documents

Medical Providers
Dental Provider
Vision Provider
Flexible Spending Accounts
Disability Plans
Life and AD&D Insurance
Employee Assistance
Legal Services

You will need Adobe Reader to view the PDFs below. Download it free. More forms will be added in the coming days during open enrollment.

ANTHEM:

Prudent Buyer (PPO) Plan - Summary of Benefits

CaliforniaCare (HMO Plan) - Summary of Benefits

Lumenos with HSA Plan - Summary of Benefits

Prescription Drug Benefits

Prescription Drug Benefit List

PPO - HMO Booklet

Anthem News - Fall 2011

KAISER PERMANENTE 2011-2012:

Summary of Benefits - 2011

Summary of Benefits - 2012

Information Booklet

Online Tools

Emergency Care Procedure

DELTA DENTAL 2011-2012:

Dental PPO Summary

Find a PPO Dentist

DeltaCare USA (HMO) Summary

Find a DeltaCare Dentist

Print an ID Card

DeltaCare Directory

Delta Dental Online Tools

Delta Dental PPO - Evidence of Coverage and Disclosure Form

VISION SERVICE PLAN (VSP) 2011-2012:

Annual Exams

Core Plan Details

Buy Up Plan Details

Evidence of Coverage and Disclosure Form

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

Plan Information

Limited Health Care FSA

2012 FSA Enrollment Form

2012 FSA Direct Deposit - Benny Card Form

2012 FSA Claim Form

2011 FSA Claim Form

FLEX-PLAN SERVICES – FLEXI-COMMUTER PROGRAM

Flexi-Commuter Program Sign Up Instructions

Flexi-Commuter Mass Transit Information

Flexi-Commuter Parking Information

DISABILITY INSURANCE:

Short Term Disability - Summary of Benefits

Short Term Disability - Frequently Asked Questions

Long Term Disability - Summary of Benefits

Long Term Disability - Frequently Asked Questions

CHAPMAN-Paid LIFE/AD&D INSURANCE:

Life/Accidental Death and Dismemberment (AD&D) - Summary of Benefits

Contingent Beneficiary Form

SUPPLEMENTAL LIFE/AD&D INSURANCE:

Supplemental Life Insurance Summary of Benefits

Supplemental AD&D Insurance Summary of Benefits

Contingent Beneficiary Form

EMPLOYEE ASSISTANCE PROGRAM - HORIZON HEALTH

Employee Assistance Program

Horizon Health September EAP Bulletin

- Financial Services

- Identity Theft Services

- Legal Services

- Coping with Disaster

LEGAL CARE INSURANCE:

Hyatt Legal Care Plan

Hyatt Legal Plans Benefits

Hyatt Legal Plans Brochure

Wellness Programs and Intiatives

October - National Breast Cancer Awareness Month!!

- Top 10 Breast Cancer Myths

- Cultivating Awareness

- The Facts about Mammograms