Benefit Forms
Health Insurance:
Blue Cross & Blue Shield of Minnesota
Phone: 866.870.0348
Group# EP606-W0
2010 OPEN ENROLLMENT FORMS AND TOOLS
- Health Enrollment Form - 2010 plan year
- Side by Side Comparison of Plans - 2010 plan year
- Health Expense Worksheet
2009 Plan Year Forms
- Health/Dental Enrollment Form (2009 plan year)
- Life Event Change Form
Dental Insurance:
Delta Dental of Minnesota
Delta Dental of Minnesota
P.O. Box 330
Minneapolis, MN 55440-0330
Phone: 800.448.3815
Group# 50814
- Dental Enrollment Form - 2010 plan year (OPEN ENROLLMENT)
- Health/Dental Enrollment Form (2009 plan year)
- Life Event Change Form
Long-Term Disability:
The Hartford
Phone: 1-800-523-2233
Policy# GLT-677664
Life Insurance:
The Standard
Phone: 503-321-7000
Policy# 146968-A
- Enrollment Form
- Evidence of Insurability form (Minnesota resident)
- Evidence of Insurability form (North Dakota resident)
Flexible Spending Accounts (FSA):
Discovery Benefits, Inc.
3216 13th Avenue South
Fargo, ND 58103
Phone: 701.451.3399
Fax: 701.451.3245
- 2010 OPEN ENROLLMENT is online. Please log in to www.discoverybenefits.com
- FSA Enrollment Form
- Discovery Benefits FSA Web site
- Reimbursement Form
Retirement Plans 403(b):
TIAA-CREF
Phone: 800.842.2776
Group# 0527
NEW! Visit the joint TIAA CREF/Concordia College site at http://enroll.tiaa-cref.org/concordia/ to:
- Enroll
- Make investment changes
- Complete a new Agreement for Salary Reduction
- Change Beneficiaries
Family Medical Leave Act (FMLA):
FMLA Poster: Employee Rights and Responsibilities under FMLA
- Certification of Health Care Provider for Employee's Serious Health Condition
- Certification of Health Care Provider for Family Member's Serious Health Condition
- Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave
- Certification of Qualifying Exigency for Military Family Leave
Tuition Discount
- Concordia Tuition Discount Information
- Concordia Tuition Discount Application
- Concordia Language Villages Tuition Discount Information
- Concordia Language Villages Tuition Discount Application
- Oak Grove Lutheran Schools Tuition Reduction Information and Application
Tuition Exchange Discount Program
- Eligibility Form and one of the following three:
- ELCA Colleges - application form
- Council of Independent Colleges – application available from Human Resources
- Tuition Exchange College – application form available from Human Resources
Benefits
