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.
Medical
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
Wellmark Preventive Services covered under The Affordable Care Act
ProAct Rx Summary – Plans A, B, C and Plan HDHP
Dental/Vision
2017 – 2018 Dental Vision Costs
Delta Dental Benefits 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 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
POLICY – SUN LIFE ASSURANCE COMPANY OF CANADA
Group Life and Accidental Death & Dismemberment Plan
Group Long Term Disability Insurance Plan
TIAA
Tuition Remission/Exchange
Employment Classifications
Voluntary Time 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.