Human Resources

Medical Forms & Resources

 
Aflac Click Here for Info

 

Applicant/Eligibility Forms

Employee Health Care Enrollment Application 2015
HIPAA Consent for Release
Medical Plan Verification 2015*
Pretax Benefit Election 2015*

*Must be completed each year

 
Change Requests

Contact Tamara Terry at (509) 242-0478

 
Request replacement medical/dental cards (only)

To replace any of your medical or dental cards, please call 888-276-4732
Please verify what address they have on file. If it is different than your current address, you will need to contact Tamara Terry at (509) 242-0478 to request your cards.

 
Reimbursement Forms

Claims Reimbursement Request Form
BlueCard PPO Out-of-Network Reimbursement Form
Medco RX Mail Order Form
Express Scripts RX Reimbursement Form
United Concordia Dental Claim Form

 
Health Care Assistance Plan (HCAP) Documents

This Plan document describes the provisions of the Health Care Assistance Plan for employees of the Seventh-day Adventist Organizations of the North American Division working in the United States (“Plan”). Please refer to the North American Division Working Policy Y 22 for the supporting general philosophy of this Plan.

2014 Health Care Assistance Plan (HCAP) Document
2014 Summary of Benefits and Coverage (SBC)
2014 Health Care Assistance Plan (HCAP) Changes

Aflac Click Here for Info

AFFORDABLE CARE ACT NOTICE:
New Health Insurance Marketplace Coverage Options and Your Health Coverage

FMLA Click Here for Info

International Insurance Click Here for Options