Benefits: Forms

 

2013-14 Open Enrollment / New Employee Benefit Forms	Last Modified	Format
Messiah College Open Enrollment Instructions	05/2013	PDF
Messiah College Open Enrollment Form	05/2013	PDF
HealthAmerica Enrollment/Change Form (MEDICAL/Rx)	05/2013	PDF
Waiver of Health Insurance Form	05/2013	PDF
Guardian Dental Enrollment/Change Form	05/2013	PDF
Capital Blue Cross Enrollment Application to Enroll or Change Enrollment (VISION ONLY)	05/2013	PDF
The Standard - Retirement Savings Form	05/2013	PDF
MetLife Voluntary Life Enrollment Kit	05/2013	PDF
Ameriflex Flexible Spending Account Enrollment Packet	05/2013	PDF

 

 

 

2012-13 New Employee Benefit Forms	Last Modified	Format
Capital Blue Cross Enrollment Application to Enroll or Change Enrollment	05/2012	PDF
Waiver of Health Insurance	05/2012	PDF
Guardian Dental Enrollment/Change Form	05/2012	PDF
The Standard - Retirement Savings Form	05/2012	PDF
MetLife Voluntary Life Enrollment Kit	05/2012	PDF
Flexible Spending Account Enrollment Packet	05/2012	PDF

 

 

 

Other Benefit Forms	Last Modified	Format
Capital Blue Cross Claim Form		PDF
Capital Blue Cross Prescription Drug Claim Form		PDF
Capital Blue Cross International Claim Form		PDF
Capital Blue Cross Vision Claim Form		PDF
Dental Only Enrollment Form		PDF
The Standard - Retirement Savings Form		PDF
Highmark Claim Form		PDF
Guardian Dental Claim Form		PDF
AmeriFlex Claim Form		PDF
Guardian Dependent Eligibility Certification Form		PDF
Request for Educational Assistance		Word
Employee Development		Word
Graduate Aid Program Application		Word
Application for Graduate Tuition Reduction	03/12	Word
Tuition Commitment for Professional Development	09/12	Word