• Benefits Home Page
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• Life Insurance
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• Flexible Spending
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• TeamHealth Home Page

Medical

• United Claim Form
• Caremark Mail Order Claim Form
• Caremark Claim Form
• Medicare D Notification - Creditable Coverage
• Medicare D Notification HDP - Non Creditable Coverage

Tobacco

• Non-Tobacco User Affidavit

Dental

• Delta Dental Claim Form

Vision

• EyeMed Vision Claim Form

Life Insurance

• Life Insurance Beneficiary
• Evidence of Insurability (EOI)

Disability/FMLA

• Filing a Short Term Disability Claim and/or Leave Request (English)
• Filing a Short Term Disability Claim and/or Leave Request (Spanish)
• Evidence of Insurability (EOI)

Travel Assistance

• Travel Assistance Brochure

401(k)/Retirement

• 401(k) Rollover Contribution Application
• SERP Enrollment Form
• QDRO
• Letter of Determination

Flexible Spending Account/HSA

• WageWorks Healthcare Spending Claim Form
• WageWorks Dependent Care Claim Form
• WageWorks Eligible Expense Guide
• OptumHealth Bank Health Savings Account (HSA) Application

Employee Assistance Programs

• Care24 Flyer
• Unum EAP Brochure

LiveWell Program

• Exercise Tracking - Second Quarter, 2012
• Tobacco Cessation
• BMI Tracking Summary
• Weight Loss Program Reimbursement
• Weight Loss Goal Completion
• Health Coaching Application

Qualifying Events

• Qualifying Event Notification Form