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
The Medical Plan summary constitutes the terms and conditions of your medical and pharmacy coverage. Click here to download the 2018 Medical Plan summary document in pdf format.
SUMMARY OF BENEFITS AND COVERAGE (SBC) DOCUMENTS
GOLD HDHP (HEALTH SAVINGS ACCOUNT) OPTION
NOTICE OF PRIVACY PRACTICE
PRESCRIPTION DRUG PLAN MAIL ORDER INFORMATION
PRESCRIPTION DRUG PLAN DOCUMENT
Click here for the Prescription Drug Plan document.
CREDITABLE COVERAGE LETTER
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 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 firstname.lastname@example.org when you have completed this process.