Benefits Forms & Resources

Provider Contact Info

• Benefits providers contact information

Forms

• Dental Claim Reimbursement
• Vision Claim Reimbursement
• Medical/Pharmacy Claim Reimbursement
• Flex Spending Reimbursement
• Prescription Drug Mail Order Enrollment
• Health Savings Account Response Form
• FMLA Leave Request
• FMLA Certification of Health Care Provider
• Long-term Sick Leave (hourly)
• Tuition Assistance
• Free Class Form
• Gift of Time (Recipient)
• Gift of Time (Donor)
• Flu Shot Form
• 2024-2025 Fitness Classes
• 2024-2025 Annual Physical

Resources & Misc Benefits

Plan Documents, Certificates, and Information

• Medical Plan Document & Summary Plan Description (SPD)
• Dental/Vision Employee Benefit Plan Document
• Retirement (Defined Contribution Plan) Summary Plan Description
• Group Long Term Disability Certificate
• Group Life & ADD Certificate
• Group Accident Plan Contract
• Group Critical Illness Contract
• Current Plan Year Information (under "Information" section)
• New Plan Year Info - 2025 Open Enrollment Flyer

Priority Health (Medical & Rx)

• Priority Health App
• What type of care do you need? VUE
• Cost Estimator
• Preventative Health Care Guidelines
• Managing Diabetes FAQ
• Mental Health
  • Toolkit
  • Member Resources
  • Teladoc
• OTC and Prescriptions
  • OTC Discount Program
  • Pharmacy Benefits Explained
  • Prescription Discount Overview
  • Express Scripts Information

UNUM Benefits

• How to file a claim
• Medical Bill Saver
• Employee Assistance Program (EAP) & Work/Life Balance - Q&A
• Travel Assistance
• Beneficiary Information
• Portability

Legal Resources

• Legal Plan Benefit
• Interactive Brochure