DOCUMENTS, FORMS, AND NOTICES
Use these quick links to navigate to the appropriate section:
BENEFITS DOCUMENTS AND NOTICES
BENEFIT PLAN DOCUMENT (WRAP)
MEDICAL PLAN DOCUMENT
SUMMARY OF BENEFITS AND COVERAGE (SBC) DOCUMENTS
GOLD HDHP (HEALTH SAVINGS ACCOUNT) OPTION
NOTICE OF PRIVACY PRACTICE
PRESCRIPTION PLAN MAIL ORDER INFORMATION
PHARMACY PLAN DOCUMENTS
CREDITABLE COVERAGE LETTER
Click here to download the Creditable Coverage Letter regarding prescription drug coverage and Medicare.
HEALTH REIMBURSEMENT ARRANGEMENT (HRA) PLAN DOCUMENT
HEALTH REIMBURSEMENT ARRANGEMENT (HRA) ADOPTION AGREEMENT
HEALTH REIMBURSEMENT ARRANGEMENT (HRA) FAQ
DENTAL PLAN BOOKLETS
TERM LIFE AND AD&D PLAN HANDBOOK
LONG-TERM DISABILITY PLAN HANDBOOK
RETIREMENT DOCUMENTS AND NOTICES
FIDELITY INVESTMENTS OPTIONS
If you prefer a hard copy, click here for a printable, 18-page booklet in pdf format. Or you also can speak with a Fidelity representative by calling Fidelity directly at (800) 343-0860.
INVESTMENT POLICY STATEMENT
DEFINED RETIREMENT CONTRIBUTION PLAN
ADDRESS AND/OR CONTACT INFORMATION UPDATE FORM
BENEFITS ENROLLMENT/CHANGE FORM
• For a new hire transferring from another Plan, coverage will commence the day following termination of coverage from their previous plan.
• For a new hire not transferring from another plan, EPC insurance benefits will begin on the first day of the month following the date of hire.
• If you are a new employee to the EPC, contact your church administrator to learn what EPC benefits are offered from the options available.
QUALIFYING LIFE EVENT/FAMILY CHANGES FORM
If you experience a Qualified Life Event, you must notify the EPC Benefits Administration Office and request benefit changes within 30 days of the event. Click here to download the EPC Benefits Enrollment/Change Form.
BENEFITS TERMINATION REPORT
TERM LIFE/AD&D/LTD PARTICIPANT FORM
BENEFITS PREMIUM PAYMENT COUPON
HSA AGREEMENT—EXCEPTION DOCUMENT (OPT-OUT)
FIDELITY 403(b)(9) ACCOUNT APPLICATION AND BENEFICIARY FORM
Click here to download the Fidelity 403(b)(9) Retirement Account Application and Beneficiary Designation Form. A completed form is required to open a new account. Note that this form is not a fillable pdf; it will need to be printed and filled out by hand.
Click here to complete your application online. Once you’ve completed your enrollment, print your confirmation page and submit this to your church administrator. Church Administrators: please contact Rebeca Santana at email@example.com when you have completed this process.
FIDELITY 403(b)(9) BENEFICIARY DESIGNATION FORM
Click here to download the Fidelity 403(b)(9) Retirement Account Beneficiary Designation Form. Note that this form is not a fillable pdf; it will need to be printed, filled out by hand, signed, and returned to the address on the form.
FIDELITY TRANSFER/ROLLOVER/EXCHANGE FORM
Click here to download the Transfer/Rollover/Exchange form for moving assets from another investment provider to an EPC-sponsored Fidelity retirement account. You can also use this form to consolidate multiple employer-sponsored retirement accounts currently held at Fidelity. Instructions for completing the form are included.
FIDELITY RETIREMENT PLAN DISTRIBUTION FORM
EPC ADOPTION AGREEMENT
CHURCH BENEFITS ELECTION FORM
403(b)(9) RETIREMENT CONTRIBUTION FORM
TERM LIFE/AD&D/LTD SALARY UPDATE FORM
EMPLOYEE CONTRIBUTIONS SALARY REDUCTION FORM
Information provided in this web site does not constitute legally binding advice. EPC benefits are subject to the provisions of the Medical Plan and Retirement Plan documents available on this web site or in print from EPC Benefit Resources, Inc. (BRI), 5850 T.G. Lee Blvd., Suite 510, Orlando FL 32822. For more information, contact BRI at firstname.lastname@example.org or 407-930-4492 (voice and fax).