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Dental Benefits Plan Enrollment Application Only - For enrollment period of October 1-31 of every Plan Year
FSA Enrollment Form - *For enrollment period November 1-30 of every Plan Year
FSA Plan for UCC Ministries Medical Care Expense Claim Form
Qualifying Medical Care Expenses Worksheet
Domestic Partnership Statement of Financial Interdependence Form
Life Insurance (LIDI) Designation of Beneficiary Form
Life Insurance and Disability Income (LIDI) Benefit Plan Enrollment Application
Life Insurance and Disability Income (LIDI) MetLife Enrollment Change Form
Optional & Additional Life Insurance Forms
Optional Additional Death Benefit Designation of Beneficiary Form
Statement of Dependent Eligibility Beyond Limiting Age in Plan Due to Mental or Physical Handicap
Ministerial Assistance Grant Directory
Massachusetts Board for Ministerial Aid - Emergency Grant Request
Supplementation for Low-Income Households (Ministerial Assistance)
Ministerial Assistance Eligibility Criteria
Click here for documents and information related to NGLI applications
Medical (Non-Medicare) and Dental Benefits Enrollment
Medicare Advantage Plan and Dental Benefits Enrollment Form
Health Benefit Dependent Change Form
Small Employer Exemption (SEE) Form
To obtain a member-submitted claim form or international claim form, please visit the Highmark website at www.highmarkbcbs.com or contact customer service at 866.763.9471 for assistance.
To obtain a pharmacy reimbursement form, please login to your account at www.express-scripts.com or contact customer service at 800.939.3781 for assistance.
Domestic Partnership Statement of Financial Interdependence Form
Lifetime Retirement Income Plan and Other Benefits Membership Form
G120 Beneficiary Designation Form
Health Benefits Automatic Credit Reduction Form
Withholding Certificate for Pension or Annuity Payments (IRS Form W-4P)
Compensation Change Form
Compensation Change Form (Spanish) Formulario de cambio de compensación
Termination of Benefits/Employment
Termination of Benefits/Employment (Spanish) Formulario de terminación de beneficios
Post-Retirement Pension Death Benefits Form
Pre-Retirement Death Benefits for Spouse Form
Pre-Retirement Death Benefits for Non-Spouse Form
Formulario de Cambio de Compensación
Formulario de Terminación de Beneficios
Plan de Anualidad Formulario de Inscripción
Brewster Annuity Plan Membership
CHAMPS Homes Annuity Plan Membership Application
MSAG New Annuity Plan Membership Application