Forms Library


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2016-2017 Highmark Employee Benefits Digest  5468k v. 2 Sep 29, 2016, 6:34 AM Courtney Akers
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401(k) QDIA Notice - Plan Year 2017  83k v. 3 Jul 25, 2017, 12:21 PM Courtney Akers
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Benefits Enrollment and Change Form -- Effective through 7/31/2018  171k v. 2 Jul 13, 2017, 2:18 PM Courtney Akers
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2017 - 2018 Open Enrollment Memo  367k v. 2 Jul 13, 2017, 3:06 PM Courtney Akers
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401(k) Summary Plan Description  228k v. 2 Jun 30, 2015, 12:01 PM Courtney Akers
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2016 401(k) Realignment and Election Change Form  49k v. 4 Jul 13, 2017, 2:18 PM Courtney Akers
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401(k) Safe Harbor Notice - Plan Year 2017  72k v. 2 Nov 29, 2016, 2:41 PM Courtney Akers
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401(k) Enrollment Booklet (Feb 2017)  3869k v. 2 Feb 6, 2017, 8:08 AM Courtney Akers
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401(k) Enrollment Form  58k v. 2 Feb 6, 2017, 8:17 AM Courtney Akers
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UHC Base Plan vs. Buy Up vs. HDHP/HSA Plan Comparison   54k v. 3 Jul 25, 2017, 12:14 PM Courtney Akers
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2017 - 2018 Payroll Deductions for Benefits  17k v. 3 Jul 25, 2017, 12:14 PM Courtney Akers
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401(k) Participant Fee Disclosure Notice - Plan Year 2017 (updated)  111k v. 2 Jul 25, 2017, 12:19 PM Courtney Akers
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401(k) Beneficiary Designation Form   110k v. 2 Dec 14, 2011, 7:17 PM Catharine Vernon
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401(k) Death Benefit Request Form  130k v. 2 Jul 7, 2016, 11:45 AM Courtney Akers
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401(k) Death Benefit Request - Tax Notice   114k v. 4 Jul 7, 2016, 11:45 AM Courtney Akers
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401(k) Deferral Election Change Form  94k v. 2 Nov 27, 2013, 5:59 AM Catharine Vernon
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401(k) Distribution Request Form  136k v. 2 Jul 7, 2016, 11:47 AM Courtney Akers
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401(k) Distribution Request - Tax Notice   114k v. 3 Jul 7, 2016, 11:47 AM Courtney Akers
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401(k) Eligibility Requirements - 2017  92k v. 2 Jul 25, 2017, 12:14 PM Courtney Akers
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401(k) Financial Hardship Request Form  128k v. 2 Jul 7, 2016, 11:47 AM Courtney Akers
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401(k) Financial Hardship Request - Tax Notice   114k v. 2 Jul 7, 2016, 11:47 AM Courtney Akers
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401(k) Loan Application Request Form 2013  115k v. 2 Apr 29, 2013, 9:45 AM Catharine Vernon
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401(k) Overview of Participant Forms   22k v. 4 Mar 2, 2010, 7:50 PM Catharine Vernon
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401(k)Realignment and Election Change Form  86k v. 3 Jan 4, 2012, 11:54 AM Catharine Vernon
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401(k) Rollover Contribution Transmittal Form  114k v. 4 Jan 4, 2012, 11:55 AM Catharine Vernon
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FSA Direct Deposit Form  802k v. 2 Jun 15, 2017, 8:29 AM Courtney Akers
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2017-2018 FSA Enrollment Guide  10640k v. 2 Jun 19, 2017, 6:34 AM Courtney Akers
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FSA Summary Plan Description -- effective through 7/31/2018  573k v. 2 Jul 13, 2017, 3:13 PM Courtney Akers
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FSA Claim Form - effective through 7/31/18  64k v. 2 Jul 7, 2017, 9:37 AM Courtney Akers
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FSA Plan Participation Form  59k v. 7 Dec 29, 2016, 6:34 AM Courtney Akers
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2017 Corporate Division Holiday Schedule  148k v. 4 Dec 29, 2016, 6:34 AM Courtney Akers
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Federal Income Tax Withholding Form W-4  113k v. 3 Jul 13, 2017, 2:37 PM Courtney Akers
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2017 LabCorp Holiday Schedule  144k v. 4 Dec 29, 2016, 6:34 AM Courtney Akers
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2017 North Carolina State Government Holiday Schedule  149k v. 4 Dec 29, 2016, 6:34 AM Courtney Akers
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2017 Pearson Holiday Schedule  145k v. 4 Dec 29, 2016, 6:34 AM Courtney Akers
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International Travel Tips - China  346k v. 2 Jun 22, 2011, 5:43 PM Catharine Vernon
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International Travel Tips - United Arab Emirates  371k v. 2 Jun 22, 2011, 5:43 PM Catharine Vernon
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International Travel Checklist  386k v. 2 Jun 22, 2011, 5:43 PM Catharine Vernon
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Employment Application  189k v. 3 Apr 20, 2016, 10:04 AM Courtney Akers
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Form I-9 (updated 1/1/17)  552k v. 2 Dec 29, 2016, 6:33 AM Courtney Akers
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  628k v. 3 Sep 5, 2014, 12:36 PM Catharine Vernon
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Guardian Certificate of Coverage and Benefits Booklet -- Current through 7/31/2018  755k v. 2 Jul 7, 2017, 9:17 AM Courtney Akers
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Guardian Supplemental/Voluntary Life Evidence of Insurability Form  164k v. 2 Jul 7, 2016, 12:12 PM Courtney Akers
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Guardian Life Claim Form   41k v. 2 Jul 7, 2016, 12:27 PM Courtney Akers
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Guardian Life Insurance Enrollment Kit  3111k v. 2 Jul 7, 2016, 12:29 PM Courtney Akers
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Guardian LTD Claim Form  128k v. 2 Jul 7, 2016, 12:39 PM Courtney Akers
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Guardian Voluntary/Supplemental Life Insurance Enrollment Form  500k v. 2 Jul 7, 2016, 12:48 PM Courtney Akers
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Guardian Life Insurance Summary Plan Description (SPD) - 2017  61k v. 3 Jun 15, 2017, 8:15 AM Courtney Akers
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Guardian Life Insurance Summary Plan Description (SPD) - 2015  92k v. 2 Jun 30, 2015, 2:01 PM Courtney Akers
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UHC Summary Plan Description (SPD) - Plan Year Ending 7/31/16  346k v. 2 Mar 30, 2016, 2:28 PM Courtney Akers
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OPTUMRx New Prescription Main-In Order Form  496k v. 2 Jul 7, 2016, 12:55 PM Courtney Akers
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United Healthcare HIPAA Disclosure Authorization Form  86k v. 3 Jul 7, 2016, 1:02 PM Courtney Akers
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United Healthcare Prescription Reimbursement Request Form  646k v. 5 Jul 13, 2017, 2:18 PM Courtney Akers
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UHC Certificate of Coverage - Base Plan (2016)  725k v. 2 Sep 29, 2016, 7:14 AM Courtney Akers
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UHC Certificate of Coverage - Buy-Up Plan (2016)  730k v. 2 Sep 29, 2016, 7:14 AM Courtney Akers
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UHC Certificate of Coverage - Vision Plan -- Current through 7/31/2018  218k v. 2 Jul 7, 2017, 9:17 AM Courtney Akers
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Guardian Dental SPD -- Current through 7/31/2018  62k v. 3 Jul 7, 2017, 9:17 AM Courtney Akers
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Market Exchange Notice for Benefits Eligible Employees  1273k v. 3 Jun 15, 2017, 8:15 AM Courtney Akers
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Market Exchange Notice for Benefits Non-Eligible Employees  1280k v. 3 Jun 15, 2017, 8:15 AM Courtney Akers
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Summary of Benefits for United Healthcare Base Plan (2017 - 2018)   770k v. 3 Jul 13, 2017, 2:38 PM Courtney Akers
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Summary of Benefits for United Healthcare Buy-Up Plan (2017 - 2018)   685k v. 3 Jul 13, 2017, 2:38 PM Courtney Akers
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Summary of Benefits for United Healthcare HDHP/HSA Plan (2017 - 2018)   537k v. 3 Jul 13, 2017, 2:38 PM Courtney Akers
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HSA Employee Contribution Form -- effective through 7/31/2018  168k v. 2 Jul 13, 2017, 3:02 PM Courtney Akers
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Summary of Benefits for United Healthcare Base Plan -- effective through 7/31/2018  646k v. 2 Jul 25, 2017, 11:57 AM Courtney Akers
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Summary of Benefits for United Healthcare Buy-Up Plan -- effective through 7/31/2018  649k v. 2 Jul 25, 2017, 11:57 AM Courtney Akers
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Summary of Benefits for United Healthcare HDHP/HSA Plan -- effective through 7/31/2018  639k v. 2 Jul 25, 2017, 11:57 AM Courtney Akers
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United Health Prescription Drug FAQs  56k v. 2 Aug 18, 2009, 1:47 PM Catharine Vernon
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2017 Payroll Calendar  329k v. 4 Aug 1, 2017, 6:35 AM Courtney Akers
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Payroll Direct Deposit Form   125k v. 3 Jul 3, 2014, 7:42 AM Catharine Vernon
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Voice and Data Reimbursement Approval Form  91k v. 3 Aug 22, 2011, 8:44 AM Catharine Vernon
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Home Office Reimbursement Approval Form  106k v. 2 Nov 29, 2009, 5:03 PM Catharine Vernon
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NC Tax Withholding Form - W-4EZ  145k v. 4 Jul 13, 2017, 2:18 PM Courtney Akers
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NC Tax Withholding Form  172k v. 2 Mar 30, 2016, 7:30 AM Courtney Akers
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VA Tax Withholding Form   13k v. 2 Jan 6, 2014, 1:16 PM Catharine Vernon