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2017 - 2018

On this site you may access forms which are available to be viewed and printed. To access any of the following forms, click on the form you are interested in, and then use the print feature in the application it is displayed in. To view PDF files you need to get Adobe Acrobat Reader.


2017-2018 Medical Waiver Form   –  All employees who choose the medical waiver need to complete a new form yearly.

2017-2018 Medical Premium Rates

Summary of Benefits and Coverage – Plan A

Summary of Benefits and Coverage – Plan B

Summary of Benefits and Coverage – Plan C

Summary of Benefits and Coverage – HDHP

2018 Wellmark Application Form –  Use this form to change plans at open enrollment

Personal Doctor Selection Form –  Use this form with Plan B and Plan C

HSA Enrollment Form

2018 HSA Deduction Form

Wellmark Preventive Services covered under The Affordable Care Act

Glossary of Terms

Plan A Certificate

Plan B Certificate

Plan C Certificate

HDHP Certificate

ProAct Rx Summary – Plans A, B, C and Plan HDHP

Rx Contact Numbers at ProAct

SCMeds (CanaRx)

FAQ Mail Order Options

Identity Protection Flyer

Identity Protection Member QA



2017 – 2018 Dental Vision Costs

Dental Enrollment Form

Dental Benefit Summary

Delta Dental Benefits Certificate

Delta Privacy Notice

VSP Enrollment Form

Vision Benefit Summary

VSP Benefit Certificate 

VSP Out of Network Claim Form  –  Use this form if you have an out of network provider


Flexible Spending  Accounts

2017-2018 Kabel FSA Enrollment Form  –  Use this form at open enrollment to make changes to your flex spending  accounts or to add a flex spending account

2017-2018 Kabel FSA Brochure

2017-2018 FSA Reimbursement Form

Kabel – Summary Plan Description


Life Insurance

Life Insurance Enrollment Form  –  Use this form for new hires and to change beneficiaries

Evidence of Insurability Form  –  Use this form if you want to add additional optional coverage


Group Life and Accidental Death & Dismemberment Plan

Group Long Term Disability Insurance Plan



Summary Plan Document

Salary Reduction Agreement

Plan Investment Information


Tuition Remission/Exchange

Tuition Remission Application

Tuition Exchange Application


Employment Classifications

Working With Staff

Working With Faculty


Voluntary Time Schedule Reduction

Letter of Agreement

Voluntary Schedule Reduction



Payroll Forms

Payroll forms can be found in SCConnect. 


Name Change

Apply to the Social Security Administration for a new card,  provide HR with a copy of the new card to make the change.

SSA Name Change