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Home / Resources / Health Coverage and Forms

Health Coverage and Forms

2023 Corinthian Plan Renewal Documents here.

Health Plan Forms

 

  • Enrollment Form for Employer: Congregational Selection Form
  • Enrollment Forms for Employees
    • Employee Enrollment form for the following states: AZ, CA, CO, DE, FL, ID, IL, IN, IA, KS, MD, MI, MN, MT, NE, OH, OK, OR, PA, SD, VA, WA
    • Employee Enrollment form for all other states 2131086 Ee Enrollment Form CEP MCUSA TCP Non-Fraternal
    • NABCO North American Benefits Company — Life and disability enrollment form
    • Dental & Vision enrollment form for employee
  • Cancellation of coverage
  • Employer HRA Enrollment and EFT Authorization

HSA and HRA Information

 

  • TCP Health Coverage with HSA
  • Health Reimbursement Arrangement
  • Everence HSAs – A Summary for Employers
  • Section 125 Cafeteria Plan for Mennonite Church USA
  • HRA and HSA Comparison Chart for Congregations
  • Everence HSA Group Contributions
  • HSA Contribution Form
  • HRA Employee Direct Submission Authorization
  • 2024 HSA Employee and Employer Contribution

Coverage Information

 

  • 2024 CEP SPD MCUSA HDHP $1,600/$3,200 Agg. Ded
  • 2024 CEP SPD MCUSA HDHP $2,000/$4,000 Agg. Ded
  • 2024 CEP SPD MCUSA HDHP $3,000/$6,000 Agg. Ded
  • 2024 CEP SPD MCUSA HDHP $4,000/$8,000 Agg. Ded
  • 2024 CEP SPD MCUSA $1,600/$3,200 Emb Ded
  • SBC CEP MCUSA 2024 $1600 Individual Coverage Embedded Deductible
  • SBC CEP MCUSA 2024 $3200 Family Coverage Embedded Deductible
  • SBC CEP MCUSA 2024 $1600 Single Coverage HDHP
  • SBC CEP MCUSA 2024 $3200 Family Coverage HDH
  • SBC CEP MCUSA 2024 $2000 Single Coverage HDH
  • SBC CEP MCUSA 2024 $4000 Family Coverage HDH
  • SBC CEP MCUSA 2024 $3000 Single Coverage HDHP
  • Complete plan description: Summary of Benefits
  • Group Term Life
  • Overview Of Group Life And Long Term Disability **
  • Group Long Term Disability Insurance
  • Explanation of Benefits
  • Finding a Provider for your Highmark PPO Program
  • Dental Plan – (Summary of Benefits)
  • Dental Plan — Comprehensive Coverage Summary Plan Description
  • Dental – Prev & Basic Coverage SPD
  • VSP Easy Option Plan Summary
  • VSP Signature Plan Summary

    Wellness Incentives & Resources

     

    • Highmark website flyer
    • 2022 Highmark Preventive Schedule
    • Baby BluePrints – Maternity Education and Support Program
    • BCBS Complementary Wellness Discount
    • Fitness Program Discounts
    • BlueCard Worldwide Brochure
    • Blues On Call Brochure
    • Highmark BSBC Need Answers
    • The Cost of Your Health Care: What You Can Do About It

    For Updated Wellness Documents below see Wellness Incentive Webpage

    • Wellness Incentive Instructions
    • Wellbeing Conversation Flyer
    • Wellness Incentive Philosophy
    • Wellness Accountability and Support Options
    • My Wellbeing Plan & Incentive Authorization TCP
    • Wellness Exam Incentive Authorization
    • TCP Wellness Physical Exam Tips
    • Wellbeing Accountability and Support Options
    • Enrollment Form (Waived) Wellness Incentive Program
    • Wellness Incentive Philosophy TCP
    • Wellbeing Conversation Incentive Authorization

    Subsidy

     

    • Fair Balance (subsidy) Fund: Eligibility criteria
    • Application for Subsidy
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