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Benefits Flexible

Here you will find current information on the following Flexible Benefits topics:

  2007 Open Enrollment Information
  COBRA
  Coverage Options After Retirement
  Leave Without Pay (LWOP)
  Qualified Change in Status
    Qualifying Election Change Matrix

  Flexible Benefits Forms   Summary Plan Infomation

Enrollment Book 2005

arrow button image 2006 Open Enrollment Booklet Web Site
arrow button image 2006 Open Enrollment Booklet - PDF
arrow button image 2006 Flexible Benefits Program Rates

Flexible Benefit Options

The Flexible Benefits Program offers uniform benefits at competitive rates. Some of the options require medical underwriting before insurance is approved and coverage begins. The following are options available through the program:

Benefit Option Vendor Link Questions About the Plan? Call:
Vision Coverage Spectera
(Find Nearest Provider)
1-800-638-3120
        2005-Spectera Vision Care Program Brochure ( - Adobe)

 Legal Insurance Signature Legal 1-800-848-2012
 Dental Insurance
         Regular and PPO


United Concordia
(Find Nearest PPO Provider)
1-866-215-2356
         Prepaid Option

CIGNA
(Find Nearest Provider)
1-800-642-5810
         Retiree Dental  
(Metro Atlanta Area)
1-888-968-0490
1-404-656-2730
Spending Accounts SHPS
(Participant Services)
1-800-893-0763
 Life Insurance Minnesota Life (404) 522-1660 (Metro Atlanta)
1(800)660-2519 (Outside Metro Atlanta)
 Accidental Death And
Dismemberment
Minnesota Life (404) 522-1660 (Metro Atlanta)
1(800)660-2519 (Outside Metro Atlanta)
 Long-Term Care UNUM 1-888-764-3539

 Short-Term & Long-Term
Disability
The Standard 1-888-641-7186
 Specified Illness AIG (American General) 1-866-849-2958
Health Benefit Options             Dept of Community Health
      Atlanta Metro
      Outside Metro Area
      PPO Information Only
      Prescription Drug
1-404-233-4479
1-800-483-6983
1-800-483-6983
1-877-650-9342

Forms

On-line Flexible Benefits Program Materials Order Form
Change of Address Form ( - Acrobat)
Dental
Regular Option Claim Form ( - Acrobat)
United Concordia (Dental) Dependent Online Form
United Concordia (Dental) Dependent Form - Paper ( - Adobe)
United Concordia Dependent Certification Form ( - Adobe)
Nomination Postcard( - Adobe)
CIGNA Prepaid Dentist Selection ( - Adobe)
Disability Claim Packet - State of Georgia ( - Acrobat)
Disability Medical Underwriting Form
State of Georgia Customized Form( - Acrobat)
Medical History Statements - Web page for policyholders
Life & AD&D Forms & Conversion/Portability Information
Portability Information and Form ( - Acrobat)
Conversion Information and Form ( - Acrobat)
Spending Account Forms
Claim Form for Health Care Account ( - Acrobat)
Claim Form for Dependent Care Account ( - Acrobat)
Specified Illness Form
arrow button image Specified Illness Benefits Form (This download is in Adobe Acrobat format - * PDF )
arrow button image Specified Illness Claim Form (This download is in Adobe Acrobat format - * PDF )
arrow button image Specified Illness Application Form (This download is in Adobe Acrobat format - * PDF )
Life Insurance Form
arrow button image Life Insurance Beneficiary Election Form ( - Word)
arrow button image Notice of Death Claim Form (This download is in Adobe Acrobat format - * PDF )
Life Insurance Underwriting Form ( - Adobe)
arrow button image Beneficiary Statement Form(This download is in Adobe Acrobat format - * PDF )
arrow button image Preference Beneficiary's Statement Form(This download is in Adobe Acrobat format - * PDF )
arrow button image Notice of Disability Form(This download is in Adobe Acrobat format - * PDF )
arrow button image Notice of Accidental Disemberment and Loss of Sight Claim Form(This download is in Adobe Acrobat format - * PDF )
arrow button image Notice of Claim for Accelerated Benefit Form(This download is in Adobe Acrobat format - * PDF )
arrow button image Waiver of Premium Claim Employer's Statement(This download is in Adobe Acrobat format - * PDF )
Qualifying Change In Status Form ( - Word)
Military Differential Pay Form ( - Word)

For more information on viewing, printing and filling out forms, visit our help page.

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Summary Plan Description
Short-Term and Long-Term Disability ( - Acrobat)
Employee Life, Spouse Life, Child Life and Accidental Death & Dismemberment ( - Acrobat)
Long Term Care ( - Acrobat)
Dental Regular and PPO Insurance( - Acrobat)
Dental Prepaid( - Acrobat)
Legal Insurance ( - Acrobat)
Spending Accounts( - Acrobat)

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