Important Benefits Forms
Health Insurance Forms
| BCBS Enrollment, Change, Waiver Form | Eligible Clergy & Laity | Enroll in coverage, add a dependent, change address, change name, waive initial coverage |
| Coverage Cancellation Form | Covered Clergy & Laity | Drop a dependent from health insurance plan |
| Covered Clergy & Laity | For expenses incurred with non-network dentist (network dentist file for you) | |
| Covered Clergy & Laity | File a claim with BCBS for medical, vision, and/or prescription expenses | |
| Church Benefits Authorization [EFT] | Church Finance Staff | Authorize payments directly from church bank account for Benefits bill |
| LAUMC- Retiree/Spouse Health premium Deductions Authorization | Retired Clergy Surviving Spouse |
Authorize the General Board of Pension & Health Benefits to deduct the health insurance premium from pension check |
Health Savings Account Forms
| Additional Deposit Form | Church Finance Staff | Send clergy payroll withholding for HSA to AHR |
| Change Form | Eligible Clergy & Laity | Make changes in address, name, contribution amounts |
| Claim Form | Eligible Clergy & Laity | Send in claims to be paid on the account (can also be done on-line) |
| Eligibility For Contributions | Eligible Clergy & Laity | Annual verification of eligibility to participate in an HSA |
| Enrollment Form | Eligible Clergy & Laity | Clergy or laity covered by the health insurance enrolling for an HSA |
Pension Forms
| Contribution Election | Eligible Clergy & Laity | Specify UMPIP contribution amounts |
| Church Benefits Authorization [EFT] | Church Finance Staff | Authorize payments directly from church bank account for Benefits bill |
| Designation of Beneficiary for Retirement/Welfare Participant | Eligible Clergy & Laity |
Name a beneficiary to receive retirement and other Wespath benefits in the event of participants death |
| Enrollment Form for Clergy and Laity |
Eligible Clergy & Laity |
Clergy and Laity enrolling in UMPIP, CRSP, CPP |
| Waiver Of Participation [CRSP] | Eligible Clergy | To waive participation in CRSP by a clergy person serving less than full time |
| Waiver Of Participation [UMPIP] | Eligible Clergy | For ¼ time clergy to waive participation in UMPIP |
