Document Library - NCMS Plan

BROUGHT TO YOU BY:
North Carolina Medical Society
Sentinel Benefits Consulting

BROUGHT TO YOU BY:
North Carolina Medical Society
Sentinel Benefits Consulting

Document Library

Health - Employer Forms

Request for Proposal (Group Size 1-15)
Request for Proposal (Group Size 16+)
New Group Application
Employer HSA Addendum

Health - Member Forms

Member Enrollment & Change Form (Group Size 1-15)
Member Enrollment & Change Form (Group Size 16+)
Domestic Partner Affidavit
Coverage Declination Form
Employee HSA Addendum
Medical Claim Form
Prescription Drug Claim Form

Dental - Employer Forms

Request for Participation
Dental Application Form
EFT Request Form
MetLink – Online Administrative Access Form

Dental - Member Forms

Employee Enrollment Form
Employee Change Form
Dental Claim Form

Life - Employer Forms

Life Product Selection Form
Salary Update Form

Life - Member Forms

Evidence of Insurability
Enrollment Application & Change Form
Life Claim Form

Compliance Documents

Notice of Privacy Practices
Summary of Annual Report
Medicare Part D – 2024