Medical Plan* (MSC Premera Blue Cross)
(Available on the first of month following 90 day eligibility period)
Enrollment Form
Affidavit of Domestic Partnership
Subscriber Claim Form
Prescription Drug Reimbursement Form
Other Miscellaneous Forms

Dental Plan* (Principal Financial)
(Available on the first of month following 90 day eligibility period)
Enrollment/ Change Form
Dental Claim Form
Election of Continued Coverage (COBRA) Form

Disability Insurance* (Sun Life Insurance)
(Available on the first of month following 1 year seniority)
Enrollment Form
Short Term Disability Claim Form

The following forms are utilized for Long Term Disability claims
All sections must be completed and signed appropriately
This form is primarily for New York groups as some states have different forms

Attending Physicians Statement of Disability
Long Term Disability Claim Form

Life Insurance* (Fortis Life)
(Available on the first of month following 90 day eligibility period)
Enrollment Form

* Indicates a Benefit for Full Time Employees only.

To read some of the links on the web site you need Adobe Acrobat Reader.
You can get an Adobe Acrobat Reader free by clicking here

and following the instructions or go to
http://www.adobe.com/products/acrobat/readstep.html
with your web browser for the free download.