Retirement Benefits Forms

• Church EFT Pension Authorization Form - Authorize payments directly from church bank account for clergy pension contributions.
• UMPIP Contribution Election Form- Completed by the salary-paying unit and submitted directly to Wespath. Specify Before-tax, Roth, and After-tax personal contribution amounts to UMPIP.
• Beneficiary Designation for Retirement and Welfare Plans – Participant - Name a beneficiary to receive retirement benefits in the event of participant's death.

Group Health Benefits (GHB) Forms

Active Clergy / Active TAC Fiscal Office Lay Employees

• GHB Enrollment Form- Enrolling in group health benefits for new clergy; newly eligible TAC lay employees; eligible clergy and lay employees during open enrollment.
• GHB Change Form - Make qualified changes outside of the Annual Open Enrollment Period, such as a change of name or address, adding dependent coverage within 31 days of a qualified life event (e.g. birth, adoption, marriage, or loss of other coverage), or termination of dependent coverage.
• UMR Medical Claim Form - Reimbursement of out-of-network claims and/or out-of-pocket expenses.
• EFT - Church GHB Authorization Form - Authorize payments directly from church bank account for clergy health coverage.
• EFT - Medical Leave GHB Authorization Form - Authorizes payments from your bank account for your Group Health contributions.
• Adoption Reimbursement Form - Expenses incurred in the adoption of a child.

Under 65 

• U65 GHB Enrollment Form - Enrolling in group health benefits for Under 65 (U65) Early Retirees / Under 65 (U65) Spouses of Medicare Primary Participants / Under 65 (U65) Surviving Spouses / Under 65 (U65) Other Dependents of Medicare Primary Participants. 
• U65 GHB Change Form - Make qualified changes outside of the Annual Open Enrollment Period, such as a change of name or address, or termination of dependent coverage.
• EFT – Retiree/Surviving Spouse Group Health Authorization form - Authorizes payments from your bank account to maintain Group Health coverage.
• UMR Medical Claim Form - Reimbursement of out-of-network claims and/or out-of-pocket expenses.
• Adoption Reimbursement Form - Expenses incurred in the adoption of a child.

Bariatric Surgery

• Requirements and Checklist Package - Requirements and procedures for bariatric surgery benefit.
• Commitment Form - Commitment Form for bariatric surgery.

TAC Wellness Program Forms

• 2024 Annual Maintenance Incentive Form - Submit for the Annual Maintenance Incentive request.
• Weight Loss Incentive Form - Submit for a Weight Loss Incentive request.
• Pregnancy Weight Loss Incentive Form - Submit for a Pregnancy Weight Loss Incentive request.