General documents
- Group Benefit Program 2010
- 2010 Rates
Plan change request forms
- ACH Funds Transfer Form
- Termination of Benefits or Employment Form
- Waiver of Health Insurance Form
- Health Insurance Addition Form
- Retiree Dependent Addition Form
- Single to Family Dependent Addition Form
- Spouse or Dependent Termination Form
- Student or Newborn Dependent Addition Form
- Transfer of Benefits Form
- Life Insurance Beneficiary Update Form
To obtain an application, please contact Bethany Benefit Service for an enrollment packet.
Claim forms
- Highmark BCBS Medical Claim Form
- Highmark BCBS Medical International Claim Form
- Delta Dental Claim Form
- TruAssure Vision Claim Form
- Express Scripts Prescription Claim Form
- Express Scripts Prescription International Claim Form
Benefits information
- Highmark BCBS Program Books
- Delta Dental Schedule of Benefits
- TruAssure Vision Schedule of Benefits
- Unum Life Insurance Schedule of Benefits
- 2010 Preventative Health Schedule
- Medicare Formulary Description
- 2010 Prescription Drug Formulary
