General documents
Plan change request forms
- ACH Funds Transfer Form
- Termination of Benefits or Employment Form
- Waiver of Health Insurance Form
- Health Insurance Addition Form
- Life & Long-term Disability Addition Form
- Dependent Addition Form
- Spouse or Dependent Termination Form
- Transfer of Benefits Form
- Life Insurance Beneficiary Update Form
To obtain an application, please contact Bethany Benefit Service for an enrollment packet.
Claim forms
- Highmark BCBS Medical Claim Form
- Highmark BCBS Medical International Claim Form
- Delta Dental Claim Form
- TruAssure Vision Claim Form
- Express Scripts Prescription Claim Form
- Express Scripts Prescription International Claim Form
Benefits information
- Highmark BCBS PPO Program Book
- Highmark BCBS Indemnity Program Book
- Highmark BCBS Medicare Supplemental Program Book
- Delta Dental Schedule of Benefits
- Delta Dental Enhanced Benefits Outline
- TruAssure Schedule of Benefits
- Unum Life Insurance Schedule of Benefits
- 2010 Preventative Health Schedule
- 2010 Prescription Drug Formulary
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