Medical Insurance

Enrollment Add/Delete Form

Diocese of Stockton SPD Final 2014

 

DOS Medical Summary of Benefit Coverage 2018-2019
DOS Summary of Benefit Coverage 2018-2019
PlushCare Overview Brochure 0316 A
PlushCare Overview Brochure 0316 B
 

Dental Insurance

PREMIER Enrollment Form
Premier Access PPO Dental Summary 2018
PREMIER DENTAL SPD
A Student Certification Form
PREMIER ACCESS PPO Certificate of Insurance
 

Vision Insurance

Superior Vision Northern CA Providers
A Student Certification Form
 

Wellness Information

DOS 2018-19 Wellness Flyer
DOS Wellness Portal Instructions 2018-19
DOS Physician Screening Form 2018-19
 

Flexible Spending Accounts

Flex Enrollment Form 2018
Flex Claim Form 2018
RCB – Flex – Complete Employee Packet 2018
RCB – Flex – SPD – 2018
 

Symetra

CoreLife/LTD Policies/Coverage

POLICY Life E-Cert Class 1 NB 0714
POLICY LTD E-Cert Class 1 NB CLERGY 0714
POLICY LTD E-Cert Class 2 NB LAY 0714
EMP CORE LIFE Benefit Summary 2015
EMP CORE LTD Benefit Summary Lay EE's 2015
EMP CORE LTD Benefit Summary Priests 2015
 

Voluntary Life

6 VOL LIFE Customized Enrollment Form – 2018
6B VOL LIFE decline enroll form
EMP VOL LIFE Benefit Summary 2015
Symetra Beneficiary Form
Evidence of Insurability Symetra
 

Pension Plan

Lay Pension Beneficiary Designation Form
WITHDRAWAL FORM PARTICIPANT DISTRIBUTION NOTICE 0518

 

Print This Page Print This Page