Life Insurance

·      AD&D Benefit Highlight Sheet

Explains the general purposes of Accidental Death & Dismemberment Insurance.

 

·      AD&D Enrollment Form

Enrollment form for Accidental Death & Dismemberment Insurance. (This is voluntary insurance.)

 

·      Adventist Risk Management Personal Risk Information

Adventist Risk Management website with access to various forms relative to AD&D, Group Life, Long-term Disability, and Supplemental Life.

 

·      Beneficiary Designation Form

Name initial beneficiaries for Group Life Insurance (provided by employer) or change prior beneficiaries. May also name beneficiaries for Supplemental Life and Accidental Death & Dismemberment Insurance.

 

·      Group Life Policy

Certificate of Insurance for Group Life Insurance (provided by employer).

 

·      Group Life Waiver and Release

Official form for waiving increased benefit coverage for Group Life Insurance.

 

·      Group Life Waiver Option Form

Choose either to accept or waive the increased benefit coverage for Group Life Insurance.

 

·      Long Term Disability

Certificate of Insurance for Long Term Disability Group Benefit Plan.

 

·      Supplemental Life Benefit Highlight Sheet

Explains the general purposes of Supplemental Life Insurance.

 

·      Supplemental Life Enrollment Form

Enrollment form for Supplemental Life Insurance. (This is voluntary insurance.)

Health Care Assistance Plan (HCAP)

·      Adventist Risk Management Website

Access to forms for the various life insurances as well as health care assistance plan forms and policies.

 

·      ARM Claim Reimbursement Request Form

Request reimbursement for:

• Acupuncture
• Chiropractic
• Massage
• Vision
• LASIK
• Hearing Aid
• Adult Immunizations

 

·         Blue Cross Reimbursement Request Form

Request reimbursement for medical claims that are not reimbursed by ARM (as noted above).

 

·      Blue Cross Website

Find a provider within the PPO Network. Our plan provider is National BlueCard PPO. Login into your account where you can view your claims, request a new ID card, print a temporary ID card, and more.

 

·      Health Care Assistance Plan (2012)

Describes the health care assistance plan in detail.

 

·      Medco Rx Reimbursement Form

Request reimbursement for prescriptions purchased at retail pharmacies.

 

·      Medco Rx Mail Order Form

Complete this form and send it to Medco with your prescriptions.

 

·      Short Term Medical

Temporary health insurance designed for people who are between permanent health plans.

 

·      United Concordia Dental

Find a dentist in the PPO Network. Our dental network is Concordia Advantage Plus.

 

·      United Concordia Dental Claim Form

Claim form for people who choose to see an out-of-network dentist.

 

·      United Concordia Dental Claim Form - Instructions

Instructions for people who choose to see an out-of-network dentist.

 

·      Verification of Health Care Coverage for Adult Children

Certify eligibility for each child age 19 and above who is enrolled in our health care assistance plan.

Leave of Absence

·      Leave Notice Request

Application for leave of absence.

New Employee

·      Background Check Authorization

Authorization form for submitting to a background check.

 

·      Personal Information Request Form

Completion of this form helps us either find your current service record or start a record if you are a new denominational employee.

           

Payroll

·      Direct Deposit Authorization Form

Authorization for Southwestern Adventist University to deposit your pay directly into your bank account.

 

·      I-9 Form

Federal form which establishes employee identity and employment authorization.

 

·      Online Travel & Miscellaneous Report

Provides online assistance in filling out and printing your expense report. Attach receipts and submit to financial vice president’s office.

 

·      W-4 Form

Employee’s withholding allowance certificate.

Retirement

 

·      Adventist Retirement Plan Website

Access a video, Leaving Money on the Table, which outlines the importance of prudently planning for retirement by participating in the Adventist Retirement Plan.

 

·      Alternate Beneficiary Designation Form

Designate someone other than spouse as the beneficiary of employee’s Adventist Retirement Plan account. 

 

·      Answers to Your Questions About Retirement

Also known as the “Pink” book, this is a summary of the Seventh-day Adventist Retirement Plan of the North American Division—the defined benefit plan.

 

·      Defined Benefit Plan

Also known as the “Blue” book, this is the detailed policy book of the Seventh-day Adventist Retirement Plan of the North American Division-the defined benefit plan.

 

·      Salary Reduction Agreement (SRA)

Designate a voluntary contribution to the Adventist Retirement Plan (ARP) and name a primary and secondary beneficiary.

 

·      SHARP Booklet

Introduces the North American Division Supplemental Healthcare Adventist Retirement Plan (SHARP), and gives eligible retirees the opportunity to select benefit options.

 

·      Summary Plan Description

Summary of the Adventist Retirement Plan (ARP), a defined contribution plan.

 

·      Thinking of Retiring?

A pre-retirement syllabus for Adventist employees.

 

·      VALIC Adventist Retirement

Access your account, print forms, learn about Guided Portfolio Services, view investment options, view retirement overview, and more.

 

·      VALIC Financial Advisor

Mr. Shane Freeman

14643 Dallas Parkway, Suite 775

Dallas, TX 75254-8839

Office: 800-892-5558 Ext. 87134

Fax: 972-490-1773

Email: shane.freeman[at]valic.com