DIOCESAN PROVIDED BENEFITS

Lay Employee Benefits – 2021-2022

Medical

Open Enrollment Information & Employee Memo – 2021-2022

Anthem Medical and Vision Summary of Benefits – 2021-2022

PPACA Summary of Benefits and Coverage Required Disclosure

US Government Annual Health Plan Notices

Medical Insurance Rates – 2021-2022

Anthem Application Form

Anthem Application Form – Excel Fill-In

Anthem Application Form – Paper Form

Anthem Live Health Online Program

Anthem Certificate Request Form

Diocesan EAP Program

Delete Form – Medical

Pension Plan (Defined Benefit)

Pension Plan Booklet

Pension Plan – Web Portal User Guide

Retirement Benefit Example

Pension Plan Participation Waiver Form

OPEN ENROLLMENT FORMS – The following three forms are ONLY applicable during the open enrollment period (month of October) for employees that have previously opted out of participation and wish to re-join the plan.  All new hires are automatically enrolled in the Pension Plan and complete all applicable forms during the hiring process.

Pension Plan Enrollment Form

Pension Plan Beneficiary Designation

Pension Plan Employment Record Form

Tax sheltered Retirement Plan (403b Account)

403b Memo 2021-2022

VOLUNTARY EMPLOYEE BENEFITS

Voluntary Insurance Summary of Benefits – 2021-2022

Voluntary Insurance & Flexible Spending Enrollment Form – 2021-2022

Dental Plans

Dental Care Plus

Dental Care Plus Brochure (including rates) – 2021-2022

Dental Care Plus Total Vision Service Plan

Dental Care Plus Hearing Service Plan

Dental Care Plus Portal Instructions

HIPAA Privacy Notice

Insurance Plans

Group Term Life Insurance Rates – 2021-2022

Long Term Disability Insurance Rates – 2021-2022

Universal Life Insurance

Universal Life Information

Universal Life Application

Premiums

Universal Life Premiums – Weekly ($4/$6/$8)

Universal Life Premiums – Weekly ($10/$12/$14)

Universal Life Premiums – Policy Value ($25k/$50k/$100k)

Long Term Care Insurance

Long Term Care Insurance Program

Long Term Care Insurance Information

Long Term Care Insurance Brochure

Auto-Home Insurance

Auto-Home Insurance Discount Program

Request for Auto/Homeowners Quote

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Flexible Spending Accounts

Contact Information

Flexible Spending Enrollment Brochure

Flexible Spending Summary Plan Description

Flexible Spending – Carryover Provisions

Flexible Spending Claim Form

Identity Theft Protection & Legal Services

Legal Shield~ID Shield Brochure – 2021-2022

Legal Shield~ID Shield Application – 2021-2022

Banking and Credit Union Options

Republic Bank

Northern Kentucky Educators Credit Union

Cove Federal Credit Union

Cove Credit Union – K-12 Tuition Loan Brochure