Benefit Forms

-www.enrollingiseasy.com - to make changes to your benefit due to a "qualifying event" (i.e. loss of coverage, marriage, birth/adoption, etc.) outside of open enrollment or to enroll as a new employee.

-"Company Key" is LEMOYNE (case sensitive)
 
MEDICAL, RETIREMENT, SUPPLEMENTAL BENEFITS

Health Insurance (Excellus BCBS)
Dental Insurance (Excellus BCBS)
Login to www.enrollingiseasy.com to access claim forms, authorization releases, etc.

Health Savings Account (Lifetime Benefit Solutions)
*Only available for employees enrolled in the SimplyBlue High Deductible Health Plan
HSA-Contribution Change.pdf

Retirement Benefits - 403(b) & Supplemental Retirement (TIAA-CREF)
Salary Reduction Agreement.pdf

Cancer, Accident & Hospital Policies (AFLAC)
Go to www.aflac.com for claim forms or to submit a claim online
https://www.aflac.com/individuals/file-a-claim/default.aspx

Flexible Spending Accounts (Lifetime Benefit Solutions)
www.lifetimebenefitsolutions.com

Auto & Home Insurance (MetLife)
 Auto - Home Fact Finder Form.pdf

 

 

 

 
REPORTING AN INJURY, LEAVE & DISABILITY FORMS, TUITION FORMS
*Reporting an Injury at Work - Worker's Compensation Form
 

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