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Employee Benefits Downloadable Forms

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 CategoryTitleSize (Kb) 
Administrative Associated Mutual Change of Beneficiary 105.47Download
Administrative Assurant Change of Beneficiary217.90Download
Administrative Coordination of Benefits19.35Download
Administrative Dependent Eligibility Verification19.49Download
Administrative Group Insurance Change Form31.08Download
Administrative HRA Best Practices for Employers41.59Download
Administrative Medicare Creditable Coverage53.25Download
Administrative Model Creditable Coverage Notification53.25Download
Administrative Reliance Standard Beneficiary Designation 40.97Download
Administrative Report of Salary Changes247.11Download
Administrative Report of Terminations12.35Download
Administrative Self-Funded ACH Authorization43.24Download
Administrative SET Direct Payment Authorization5.68Download
Administrative Travel Accident Beneficiary26.95Download
ApplicationBCBSM Enrollment/Change Forms169.54Download
ApplicationReliance Standard Group Life Conversion72.35Download
ApplicationRSLI Voluntary Life EOI109.93Download
ApplicationSET Group Subscriber Application151.08Download
ApplicationStatement of Health28.17Download
ApplicationVoluntary Group Term Life79.58Download
Claim Associated Mutual Group Life347.33Download
Claim Associated Mutual Hospital Indemnity74.41Download
Claim Associated Mutual LTD Claim32.51Download
Claim Associated Mutual Waiver of Premium18.06Download
Claim Assoicated Mutual STD Claim Form24.76Download
Claim Assurant Disability Claim Statement-Life514.87Download
Claim Assurant Group Life932.87Download
Claim Assurant LTD Claim Form691.79Download
Claim BASIC Flex Claim Form317.63Download
Claim BCBSM Master Medical Claim Form64.84Download
Claim BCBSM Member Application for Payment149.64Download
Claim Benzie County Central Claim Form17.34Download
Claim Fort Dearborn Waiver of Premium212.75Download
Claim Kalkaska Prescription Co-Pay Form25.49Download
Claim Reliance Standard Accelerated Benefit161.99Download
Claim Reliance Standard Group Life178.37Download
Claim Reliance Standard LTD479.97Download
Claim Reliance Standard STD Claim Form216.09Download
Claim Standard Insurance Company Waiver of Premium for Life347.65Download
Claim Supplemental Health Care Coverage Claim Submission Procedures126.29Download
Claim Travel Accident ADD136.68Download
Claim Travel Accident Death170.22Download
Claim Traverse Bay ISD Medical Reimbursement123.80Download
Claim Vision5.90Download
HRA HRA Best Practices for Employers41.59Download
HRA HRA Employee Summary35.56Download
HRA HRA Reimbursement381.56Download
HRA HRA Verification Form60.59Download
HSA EOB-HSA Register56.83Download
Prescription BCBSM Prescription Drug Claim30.50Download
Prescription Medco Mail Order 1,166.75Download
Prescription Memphis CS Prescription Co-Pay Reimbursement20.54Download
415 W. Kalamazoo St. Lansing, MI 48933-2079 Phone 517.482.0871 Toll-Free 1.800.292.5421 Fax 517.492.0883