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 ends on November 19th.

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