Employee Forms and Resources
Explains the general purposes of Accidental Death & Dismemberment Insurance.
Enrollment form for Accidental Death & Dismemberment Insurance. (This is voluntary insurance.)
Adventist Risk Management website with access to various forms relative to AD&D, Group Life, Long-term Disability, and Supplemental Life.
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.
Certificate of Insurance for Group Life Insurance (provided by employer).
Official form for waiving increased benefit coverage for Group Life Insurance.
Choose either to accept or waive the increased benefit coverage for Group Life Insurance.
Certificate of Insurance for Long Term Disability Group Benefit Plan.
Explains the general purposes of Supplemental Life Insurance.
Enrollment form for Supplemental Life Insurance. (This is voluntary insurance.)
Health Care Assistance Plan (HCAP)
Access to forms for the various life insurances as well as health care assistance plan forms and policies.
Request reimbursement for:
- Hearing Aid
- Adult Immunizations
Request reimbursement for medical claims that are not reimbursed by ARM (as noted above).
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.
Describes the health care assistance plan in detail.
Request reimbursement for prescriptions purchased at retail pharmacies.
Complete this form and send it to Medco with your prescriptions.
Temporary health insurance designed for people who are between permanent health plans.
Find a dentist in the PPO Network. Our dental network is Concordia Advantage Plus.
Claim form for people who choose to see an out-of-network dentist.
Instructions for people who choose to see an out-of-network dentist.
Certify eligibility for each child age 19 and above who is enrolled in our health care assistance plan.
Leave of Absence
Application for leave of absence.
Authorization form for submitting to a background check.
Completion of this form helps us either find your current service record or start a record if you are a new denominational employee.
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.
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.
Access a video, Leaving Money on the Table, which outlines the importance of prudently planning for retirement by participating in the Adventist Retirement Plan.
Designate someone other than spouse as the beneficiary of employee’s Adventist Retirement Plan account.
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.
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.
Introduces the North American Division Supplemental Healthcare Adventist Retirement Plan (SHARP), and gives eligible retirees the opportunity to select benefit options.
Summary of the Adventist Retirement Plan (ARP), a defined contribution plan.
A pre-retirement syllabus for Adventist employees.
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