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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2016 - 2017 Payroll Deductions for Benefits  39k v. 2 Dec 22, 2016, 1:01 PM Courtney Akers
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2016 - 2017 Summary of Benefits  76k v. 2 Dec 22, 2016, 1:01 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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401(k) Eligibility Requirements  20k v. 3 Jul 7, 2016, 11:58 AM Courtney Akers
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401(k) Safe Harbor Notice for 2016  74k v. 2 Jul 7, 2016, 12:07 PM Courtney Akers
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QDIA Notice for 2016  84k v. 2 Jul 7, 2016, 12:52 PM Courtney Akers
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2016 401(k) Realignment and Election Change Form  49k v. 2 Sep 29, 2016, 7:40 AM Courtney Akers
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401(k) Participant Fee Disclosure - Plan Year 2017  104k v. 2 Nov 29, 2016, 2:40 PM Courtney Akers
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401(k) QDIA Notice - Plan Year 2017  83k v. 2 Nov 29, 2016, 2:41 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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401(k) Participant Fee Disclosure  81k v. 2 Oct 5, 2015, 7:49 AM 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) 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 Claim Form - 2014  64k v. 2 Jul 1, 2014, 8:12 PM Catharine Vernon
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FSA Enrollment Guide - 2015  1957k v. 2 Jun 30, 2015, 2:02 PM Courtney Akers
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FSA Direct Deposit Form  148k v. 4 Sep 9, 2009, 7:40 PM Catharine Vernon
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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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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  755k v. 2 Mar 30, 2016, 11:16 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) - 2015  92k v. 2 Jun 30, 2015, 2:01 PM Courtney Akers
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2015 Benefits Enrollment and Change Form  170k v. 6 Jun 30, 2015, 12:11 PM Courtney Akers
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UHC Certificate of Coverage - Vision Plan  334k v. 2 Mar 30, 2016, 2:28 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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Summary of Benefits for United Healthcare Base Plan (2016 - 2017)  203k v. 2 Jul 7, 2016, 1:27 PM Courtney Akers
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Summary of Benefits for United Healthcare Buy-Up Plan (2016 - 2017)  204k v. 2 Jul 7, 2016, 1:28 PM Courtney Akers
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Summary of Benefits for United Healthcare Rx Plan (2016 - 2017)  119k v. 2 Jul 7, 2016, 1:20 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. 3 Jul 7, 2016, 1:18 PM Courtney Akers
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United Healthcare Base Plan vs. Buy Up Plan Comparison  249k v. 2 Jul 8, 2016, 9:55 AM Courtney Akers
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2016 - 2016 Open Enrollment Memo  506k v. 2 Jul 8, 2016, 11:21 AM 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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Summary of Benefits for United Healthcare Base Plan (2015)   356k v. 2 Sep 29, 2016, 6:40 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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Summary of Benefits for United Healthcare Buy-Up Plan (2016)   357k v. 2 Sep 29, 2016, 6:40 AM Courtney Akers
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UHC Certificate of Coverage - Vision Plan   218k v. 2 Nov 29, 2016, 2:46 PM Courtney Akers
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2015 Benefits Enrollment Memo  123k v. 5 Dec 29, 2016, 6:24 AM Courtney Akers
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Guardian Dental Summary Plan Description (SPD) - 2015  153k v. 4 Dec 29, 2016, 6:24 AM Courtney Akers
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United Healthcare Medical Form  114k v. 2 Jan 4, 2010, 5:56 PM Catharine Vernon
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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. 2 Dec 29, 2016, 6:02 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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Visit Access Request Form  115k v. 2 Dec 22, 2009, 8:16 AM Catharine Vernon
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I-9 Employee Eligibility Form (as of 3/08/13)  462k v. 2 Mar 25, 2013, 1:47 PM Catharine Vernon
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NC Tax Withholding Form - W-4EZ  145k v. 2 Mar 30, 2016, 7:31 AM 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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Federal Income Tax Withholding Form W-4  113k v. 2 Jan 23, 2017, 10:46 AM Courtney Akers
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VA Tax Withholding Form   13k v. 2 Jan 6, 2014, 1:16 PM Catharine Vernon