Important Forms

We try to do as much as we can online, but there will always be forms to deal with.
Here is a collection of links to the most important forms relating to your benefits.

Document What it's for... Who it's for...
Pension Forms 
UMPIP Contribution Election Form Eligible clergy and laity Specify Before-tax, Roth, and After-tax personal contribution amounts to UMPIP
Beneficiary Designation for Retirement and Welfare Plans – Participant Eligible clergy and laity Name a beneficiary to receive retirement benefits in the event of participant's death
Church EFT Pension Authorization Form Church financial personnel Authorize payments directly from church bank account for clergy pension contributions
CRSP/UMPIP/CPP Enrollment Eligible clergy Enroll in CRSP, UMPIP, CPP
UMPIP Enrollment Eligible laity Enroll in UMPIP
Group Health Benefits Forms  
TAC Group Health Benefits Enrollment Form New clergy; Newly eligible TAC lay employees; Eligible clergy and lay employees during open enrollment Enrolling in group health benefits
TAC Group Health Benefits Change Form Eligible clergy and lay employees Make qualified changes outside of the Annual Open Enrollment Period, such as a change of name or address, adding dependent coverage within 30 days of a qualified life event (e.g. birth, adoption, marriage, or loss of other coverage), or termination of dependent coverage
TAC Group Health Life Insurance Beneficiary Update Form Eligible active and retired clergy and lay employees Update beneficiaries for employee group health life insurance benefit through American United Life (AUL)
Boon-Chapman Annual Additional Insurance Form All Group Health Plan employee participants Confirmation of additional insurance coverage
Boon-Chapman Medical Claim Form Group Health Plan participants Reimbursement of out-of-network claims and/or out-of-pocket expenses
EFT - Church Group Health Plan Authorization Form Church financial personnel Authorize payments directly from church bank account for clergy health coverage
EFT - Medical Leave Group Health Authorization Eligible clergy on medical leave Authorizes payments from your bank account for your Group Health contributions
EFT – Retiree/Surviving Spouse Group Health Authorization form Eligible retirees and surviving spouses Authorizes payments from your bank account to maintain Group Health coverage
Adoption Reimbursement Form Active clergy and lay employee participants in the Group Health Plan Expenses incurred in the adoption of a child
Hearing Aid Benefit Reimbursement Form Active clergy Group Health Plan participants Reimbursement of eligible hearing aid expenses
Retiree Taxable Stipend form Retirees age 65 and older Application for taxable stipend
Wellness Program Forms 
2016 A-la-carte Fitness Rebate Form All Wellness Program participants Apply for a 50% refund for Health and Wellness purchases and fees paid from January 1 through September 30, 2016
Wellness Program Incentive Form All Wellness Program participants Submit to request Wellness Incentives
Physician Confirmation Form All Wellness Program participants Wellness Incentives that require physician authorization
Annual Maintenance Incentive Form All Wellness Program participants Submit for Annual Wellness Program maintenance incentives
Pregnancy Weight Loss Incentive Form All Wellness Program participants Submit request for pregnancy weight loss incentive
Prior Weight Loss Wellness Incentive Form

All Wellness Program participants

Submit to request incentive for weight loss prior to the Day of Wellness

Bariatric Surgery

Requirements and Checklist Package

Commitment Form

Group Health Plan participants Requirements and procedures for bariatric surgery benefit

 

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