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Health Benefits Information

 
   

Information Document from the Oklahoma Conference Health Benefits office

 
Director Janet A. Tofani 
Phone: 530.2069;
FAX: 530.2097
jtofani@okumc.org

Helpful Health Benefit Links

Electronic payment of health insurance form
  Insurance Forms
    YOU WILL FIND THE FOLLOWING FORMS ON THIS PAGE --Click HERE
  *   Group Health Plan Document
  *   Health Benefit Plan Report 2 (Oklahoma Conference)
  *   Health Insurance Preminums
  *   Benefits Schedule Self-Funded Medical Plan
  *   Enrollment Form Health Insurance -- Kempton Group
  *   Prescription Drug Plan Covered
  *   Prescription Drug Plan
  *   Creditable Coverage Letter
  *   Employee Assistance Program
  *   Summary Plan Description --Delta Dental
  *   Dental Vision Flyer
  *   Employee Enrollment Form --Delta Dental
  *   VSP Enrollment Form-Vision
  *   Clergy Life Enrollment form --Aetna
  *   Designation of Beneficiary form --Aetna Life Insurance
  Retirees Benefits
    YOU WILL FIND THE FOLLOWING FORMS ON THIS PAGE --Click HERE
  *   Retirees Benefit Information
  *   Letter of Creditable Coverage for Medicare D
  Flexible Benefit Plan Information(Cafeteria Plan)
    YOU WILL FIND THE FOLLOWING FORMS ON THIS PAGE -- Click HERE
  *   Flexible Benefit Plan Report 3 (Oklahoma Conference)
  *   Flexible Spending Account Summary
  *   2011 Flexible Spending Account Section Enrollment Form
  *   2010 Flexible Spending Account Section Enrollment Form may be found in our "Forms" section
  *   Employees Flexible  125 Benefit Plan Summary Plan
  *   Medical Expense Example
  *   Flexible 125 Claim Form:
  *   Flexible 125 Rollover Statement:
  *   Flexible 125 Direct Deposit Authorization:
  *   Flexible 125 Change of Status Form
  *   Flexible 125 Revoke Status Form
  Health Reimbursement Arrangement
    YOU WILL FIND THE FOLLOWING FORMS ON THIS PAGE --Click HERE
  *   HRA Reimbursement Form
  *   HRA Plan Document
  *   Health Reimbursement Agreement Report 4
  Privacy Information
    YOU WILL FIND THE FOLLOWING FORMS ON THIS PAGE --Click HERE
  *   HIPAA Notice of Privacy Practices
  *   Health Plan Privacy Policy
  *   Flexible Benefit/Cafeteria Plan Privacy Notice
  *   Delta Dental HIPAA Notice of Privacy Practices
  *   VSP HIPAA Notice of Privacy Practices