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
- TAC Active GHB Enrollment Form- Enrolling in group health benefits for new clergy; newly eligible TAC lay employees; eligible clergy and lay employees during open enrollment.
- TAC 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.
- Boon-Chapman Medical Claim Form - Reimbursement of out-of-network claims and/or out-of-pocket expenses.
- Supplemental Counseling Benefit Reimbursement Form - Reimbursement for out-of-pocket expenses paid for Supplemental Counseling Benefits.
- EFT - Church Group Health Plan Authorization Form - Authorize payments directly from church bank account for clergy health coverage.
- EFT - Medical Leave Group Health Authorization - Authorizes payments from your bank account for your Group Health contributions.
- Adoption Reimbursement Form - Expenses incurred in the adoption of a child.
- Hearing Aid Benefit Reimbursement Form - Reimbursement of eligible hearing aid expenses.
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.
- EFT – Retiree/Surviving Spouse Group Health Authorization form - Authorizes payments from your bank account to maintain Group Health coverage.
- Boon-Chapman Medical Claim Form - Reimbursement of out-of-network claims and/or out-of-pocket expenses.
- Supplemental Counseling Benefit Reimbursement Form - Reimbursement for out-of-pocket expenses paid for Supplemental Counseling Benefits.
- Adoption Reimbursement Form - Expenses incurred in the adoption of a child.
- Hearing Aid Benefit Reimbursement Form - Reimbursement of eligible hearing aid expenses.
Bariatric Surgery
- Requirements and Checklist Package - Requirements and procedures for bariatric surgery benefit.
- Commitment Form - Commitment Form for bariatric surgery.
TAC Wellness Program Forms
- 2023 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.