| Document | File Type |
|---|---|
Accidental Dismemberment or Loss of Sight Claim Form |
|
American Fidelity Health Savings Account |
|
Application for Life Premium Waiver- For use by entities WITH the EGID Disability Plan |
|
Application for Life Premium Waiver- For use by entities WITHOUT the EGID Disability Plan |
|
Certification of Previous Coverage |
|
Change of Address Form |
|
Disability Benefits Beneficiary Designation |
|
Disability Reimbursement Agreement |
|
Durable Power of Attorney |
|
Electronic Fund Transfer Authorization |
|
Medicare Complaint Form- Health or Prescription Coverage |
|
TRICARE Supplement |
|
Application for Coverage for Other Dependent Children |
|
COBRA Packet |
|
Common-Law Spouse Certification |
|
Dependent Attachment Form |
|
Disabled Dependent Assessment |
|
Exclusion for Spouse Coverage |
|
Forms
Last Modified on
Nov 20, 2023
