• Cigna Health Plan Book
• Delta Dental Book
• Standard Life Insurance Plan Book
• Flexible Benefits Book
• Voluntary Benefits Brochure
• Short/Long Term Disability Book
• 2019 Summary Benefit Comparison (SBC) 500 Deductible (Updated Oct 2018)
• 2019 Summary Benefit Comparison (SBC) 900 Deductible (Updated Oct 2018)
• 2019 Summary Benefit Comparison (SBC) 2000 Deductible (Updated Oct 2018)
• 2019 Summary Benefit Comparison (SBC) 1500 High Deductible Health Plan (HDHP) (Updated Oct 2018)

PREMIUM RATES & CALCULATORS

• 2018 Active & COBRA Premium Rates
• 2017 Life Insurance Premium Rates
• 2018 Rate Calculator (Excel)
• 2018 Rate Calculator (Manual)
• Disability Premium Calculator

APPLICATION & ENROLLMENT

• Active Benefits Application Health, Dental and Life Insurance Enrollment or Changes.
• Voluntary Benefits Application Vision & Disability Enrollment or Changes.
• 2018 Flexible Benefits Election Form
• 2019 Flexible Benefits Election Form
• Flex Benefits Change Form
• Link to Genworth site When prompted enter: Group Name: statewy Access code: groupltc
• 2018 Health Savings Account Election Form
• Long Term Disability Application Link

OTHER FORMS

• Medical Reimbursement & Dependent Care Claim Form (Updated 4/25/2017)
• 2018 Flexible Benefit Payment Schedule Claims deadlines & check mail dates.
• Qualifying Event Matrix What benefits can be changed based on a qualifying event.
• MedImpact Direct Rx Mail Order Form For use on prescriptions that did not go through a retail pharmacy.
• MedImpact Claim Form Used for manual submission of prescription reimbursement.
• Delta Dental Claim Form Used to send your claim to Delta Dental when your provider is non-participating.
• Direct Payment Authorization
• Vision Out of Network Reimbursement Claim Form
• Short Term Disability Insurance Claim Form The Standard Company 1-800-368-2859
• Long Term Disability Claim Form The Standard Company 1-800-368-1135
• Cigna Claim Form Used to send medical claims to Cigna.
• HIPAA Privacy Authorization Form

WEBSITE LINKS