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Director
Janet A. Tofani
Phone: 530.2069;
FAX: 530.2097
jtofani@okumc.org
Helpful Health Benefit Links
Electronic payment of health insurance form
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Insurance Forms |
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YOU WILL FIND THE FOLLOWING FORMS ON THIS PAGE --Click HERE |
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Group Health Plan Document |
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Health Benefit Plan Report 2 (Oklahoma Conference) |
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Health Insurance Preminums |
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Benefits Schedule Self-Funded Medical Plan |
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Enrollment Form Health Insurance -- Kempton Group |
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Prescription Drug Plan Covered |
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Prescription Drug Plan |
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Creditable Coverage Letter |
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Employee Assistance Program |
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Summary Plan Description --Delta Dental |
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Dental Vision Flyer |
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Employee Enrollment Form --Delta Dental |
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VSP Enrollment Form-Vision |
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Clergy Life Enrollment form --Aetna |
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Designation of Beneficiary form --Aetna Life Insurance |
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Retirees Benefits |
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YOU WILL FIND THE FOLLOWING FORMS ON THIS PAGE --Click HERE |
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Retirees Benefit Information |
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Letter of Creditable Coverage for Medicare D |
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Flexible Benefit Plan Information(Cafeteria Plan) |
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YOU WILL FIND THE FOLLOWING FORMS ON THIS PAGE -- Click HERE |
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Flexible Benefit Plan Report 3 (Oklahoma Conference) |
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Flexible Spending Account Summary |
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2010 Flexible Spending Account Section Enrollment Form |
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Employees Flexible 125 Benefit Plan Summary Plan |
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Medical Expense Example |
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Flexible 125 Claim Form: |
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Flexible 125 Rollover Statement: |
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Flexible 125 Direct Deposit Authorization: |
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Flexible 125 Change of Status Form |
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Flexible 125 Revoke Status Form |
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Health Reimbursement Arrangement |
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YOU WILL FIND THE FOLLOWING FORMS ON THIS PAGE --Click HERE |
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HRA Reimbursement Form |
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HRA Plan Document |
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Health Reimbursement Agreement Report 4 |
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Privacy Information |
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YOU WILL FIND THE FOLLOWING FORMS ON THIS PAGE --Click HERE |
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HIPAA Notice of Privacy Practices |
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Health Plan Privacy Policy |
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Flexible Benefit/Cafeteria Plan Privacy Notice |
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Delta Dental HIPAA Notice of Privacy Practices |
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VSP HIPAA Notice of Privacy Practices |
