All Content Forms

Annuitant Visitor

UCC Age 26 Application Form   

Dental Benefits

Certification of Same-Gender Domestic Partner as Dependent or Non-Dependent Form   

Dental Benefits Claims Form
Use this form for services received outside the United Concordia Advantage Plus network   

Dental Benefits Plan Enrollment Application Form   

Disenrollment of Domestic Partner Due to Death or Termination of Partnership Form   

Domestic Partnership Statement of Financial Interdependence Form   

UCC Age 26 Application Form   

Employers

Tax-Sheltered Annuity (TSA) Salary Reduction Agreement Form   

Flexible Spending Accounts

FSA Plan for UCC Ministries Change in Status Election Form 2010   

FSA Plan for UCC Ministries Dependent Care Claim Form 2009-2010   

FSA Plan for UCC Ministries Election Not to Participate Form 2010   

FSA Plan for UCC Ministries Medical Care Expense Claim Form 2009-2010   

FSA Plan for UCC Ministries Revocation of Benefit Election and Compensation Reduction Agreement Form 2010   

Health Benefits

Certification of Same-Gender Domestic Partner as Dependent or Non-Dependent Form   

Dental Benefits Claims Form
Use this form for services received outside the United Concordia Advantage Plus network   

Dental Benefits Plan Enrollment Application Form   

Disenrollment of Domestic Partner Due to Death or Termination of Partnership Form   

Domestic Partnership Statement of Financial Interdependence Form   

Health Benefits Plan (Non-Medicare) Enrollment Application Form   

Health Coverage Change Form   

Highmark Claim Form Instructions   

Medicare Supplement Plan Application   

Statement of Health Form   

UCC Age 26 Application Form   

Vision Benefit Plan Application   

VSP Out of Network Claim Form   

Life & Disability Benefits

Life Insurance (LIDI) Designation of Beneficiary Form   

Life Insurance and Disability Income (LIDI) Benefit Plan Application   

MetLife Privacy Notice   

Statement of Health Form   

Ministerial Assistance

Application for Student Financial Assistance for Children of Deceased/Disabled Clergy   

Pension Data Sheet   

Pension Benefits

Account Balance Distribution Form   

Annuity Fund Beneficiary Designation Form   

Annuity Fund Membership Application Form   

Designation of Beneficiary/120 Payments Form   

Direct Deposit Agreement Form   

Pension Data Form   

Post-Retirement Pension Death Benefits Form   

Pre-Retirement Death Benefits For Spouse Over Age 50 Form   

Pre-Retirement Death Benefits For Spouse Under Age 50 Form   

Request for Direct Rollover of Funds Form   

Retirement Savings Account (RSA) Application Form   

Retirement Savings Account (RSA) Fund Reallocation Form   

Tax-Sheltered Annuity (TSA) Salary Reduction Agreement Form   

Withholding Certificate for Pension or Annuity Payments
OMB No. 1545-0074