General Forms and Resources

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• 2019-2020 Benefits Guide
• Affordable Care Act – Health Care FAQ
• Cash-In-Lieu
• New Health Insurance Marketplace Coverage Options and Your Health Coverage (©2013 DOL)
• Uniform Glossary for Summary of Benefits and Coverage (© 2013 DOL.gov)

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Benefits - Standard Plans

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• Anthem Active and Fit CMS Resources
• Anthem Blue Cross Claim Form
• Anthem HMO-CAC - Benefit Summary
• Anthem PPO - Anchor Bronze - Benefit Summary
• Anthem PPO - Certificated, Confidentials, and Management Benefit Summary
• Anthem PPO - Classified Benefit Summary
• Anthem PPO - MVP - Benefit Summary
• Delta Dental Insurance Claim Form (© 2010 Denta Dental)
• Delta Dental Online Access (© 2014 Denta Dental)
• Delta Dental PPO – Selecting a PPO Dentist (© 2013 Denta Dental)
• Delta Dental Summary Plan Description (© 2014 Denta Dental)
• EyeMed Claim Form
• EyeMed Vision Care Full Service - PPO Medical Provider
• EyeMed Vision Care Materials Only- HMO Medical Provider
• Kaiser HMO - Benefit Summary
• Lincoln Financial Group - Basic Life & AD&D at a Glance
• Lincoln Financial Group - Long Term Disability Class 1 At a Glance
• Lincoln Financial Group - Long Term Disability Class 2 At a Glance
• MetLife Dental HMO
• MidAmerica Beneficiary Designation Form (© 2009 MidAmerica)
• MidAmerica Disbursement Request Form (© 2009 MidAmerica)

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Benefits - Voluntary Plans

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• AFLAC Product Overview Brochure
• AFLAC Interest Sheet
• Lincoln Financial Group - Voluntary AD&D At a Glance
• Lincoln Financial Group - Voluntary Life At a Glance
• TakeCare WageWorks Dependent Care FSA Brochure (©2014 TakeCare WageWorks)
• TakeCare WageWorks Dependent Savings Form Claim (©2014 TakeCare WageWorks)
• TakeCare WageWorks Enrollment Form (©2014 TakeCare WageWorks)
• TakeCare WageWorks – FSA Eligible HealthCare – Dependent Care Expenses (© 2012 TakeCare WageWorks)
• TakeCare WageWorks Health Savings Form Claim (©2014 TakeCare WageWorks)
• TakeCare WageWorks HealthCare FSA Brochure (©2014 TakeCare WageWorks)

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Note: If you are unable to access these documents and require additional accommodations, please contact czamora5@pasadena.edu.