Benefit Forms and Links

2013 Open Enrollment
October 23 - November 12, 2012
All forms are due by 5pm CST on November 12th.

Flexible Spending Open Enrollment begins Tuesday, October 23 and ends on November 19th at 5pm (CST).

Open Enrollment Information and Instructions:
Open Enrollment Information and Instructions

Health Insurance:
Enrollment Form
Side by Side Plan Comparison

Dental Insurance:
Enrollment Form (to cancel coverage use this form and write Cancel)
Dental Plan Summary
ID Card

Flexible Spending Account (FSA):
Flexible Spending Enrollment Instructions
Flexible Spending Guide

Life Insurance:
Enrollment Form
Beneficiary Designation Form
Evidence of Insurability

Long Term Disability:
Benefit Summary
Enrollment Form
Evidence of Insurability

Retirement Plans 403(b):
TIAA-CREF
Use the joint TIAA CREF/Concordia College site to:

Employee Assistance Program (EAP):
The Hartford
800.96.HELPS
800.964.3577
www.guidanceresources.com
ID: HLF902
Company Name: abili

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2012 Benefit Forms

Life Event Change Form

Health Insurance:
Blue Cross & Blue Shield of Minnesota
Phone: 866.870.0348
Group# EP606-W0 (Low plan)
Group# EP606-W3 (High plan)

Enrollment Form
Side by Side Plan Comparison

Dental Insurance:
MetLife
Concordia College Group #146289
www.metlife.com/mybenefits
Customer Service: 800.942.0854

Enrollment Form (to cancel coverage use this form and write Cancel)
Dental Plan Summary
ID Card

Flexible Spending Account (FSA):
Discovery Benefits, Inc.
3216 13th Ave South
Fargo, ND 58103
Phone: 701.451.3399
Fax: 701.451.3245

Understanding your Discovery Benefits FSA (Video)
Flexible Spending Guide
FSA Information

Life Insurance:
The Hartford
Phone: 800.523.2233
Group#: 402310

Enrollment Form
Beneficiary Designation Form
Evidence of Insurability

Long Term Disability:
The Hartford
Phone: 800.523.2233
Group#: 402310

Benefit Summary
Enrollment Form
Evidence of Insurability

Retirement Plans 403(b):
TIAA-CREF
Phone: 800.842.2776
Group# 0527

Use the joint TIAA CREF/Concordia College site to:

Employee Assistance Program (EAP):
The Hartford
800.96.HELPS
800.964.3577
www.guidanceresources.com
ID: HLF902
Company Name: abili

CHIROPRACTIC CARE PROVIDERS


CREDIT UNION MEMBERSHIP:
Northland Educators Credit Union

FAMILY AND MEDICAL LEAVE ACT (FMLA):
FMLA Poster: Employee Rights and Responsibilities under FMLA

Concordia's FMLA Policy
Employee Request for FMLA

Information For:

current students
faculty and staff		 parents
alumni		 high school students
admitted students