NCMS || Employee Benefit Plan

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North Carolina Medical Society
Sentinel Benefits Consulting

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Forms

The documents below require Adobe Acrobat Reader. You can download it here if you don’t already have it installed.

Health

  • Employee Coverage Declination Form
  • Employee HSA/HRA Addendum
  • Employer HRA Addendum
  • Employer Group Health Application/Change Form (1-15 Employees)
  • Employer Group Health Application/Change Form (16+ Employees)
  • Employee Enrollment/Change Application (1-15 Employees)
  • Employee Enrollment/Change Application (16+ Employees)
  • Employer HSA Addendum
  • Domestic Partner Affidavit

Dental

  • MetLink: Online Dental Benefit Administration
  • Domestic Partner Declaration
  • Employee Enrollment Form
  • Employer Dental Application Form
  • Employee Change Form
  • EFT Request Form (Electronic Payment)
  • Request for Participation

Life

  • USAble Life Evidence of Insurability
  • Enrollment Application and Change Form Addendum
  • Life Product Selection Form
  • Salary Update Form

Claim Forms

  • Dental
  • Life
  • Medical
  • Prescription Drugs

Other

  • Notice of Privacy Practices
  • North Carolina Medical Society Membership Application
  • North Carolina Medical Society Membership Verification Form

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