Retirement Benefits Forms

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 

Bariatric Surgery

TAC Wellness Program Forms