Plan Documents and Notices
The information you provide to us on each form is important. Please print legibly, or type directly on each Microsoft Word form. Please note that your insurance Enrollment Form needs to have an authorized person's approval, if applicable. Please submit all forms to the mailing address, fax number, or email address on the form.
Benefits Forms and Notices
Retirement Plan Forms and Notices
BENEFITS FORMS AND NOTICES
BENEFIT PLAN DOCUMENT (WRAP)
This document provides the information about the EPC Benefits Plan as required by the Employee Retirement Income Security Act of 1974 (ERISA). Click here to download the 2017 Benefit Plan document in pdf format.
MEDICAL PLAN DOCUMENT
The Medical Plan summary constitutes the terms and conditions of your medical and pharmacy coverage. Click here to download the 2017 Medical Plan summary document in pdf format.
SUMMARY OF BENEFITS AND COVERAGE (SBC) DOCUMENTS
Click on the appropriate Plan option below to download the SBC in pdf format. Click here for FAQs from the United States Department of Labor about SBC compliance regulations.
Click here to download the 2017 EPC Medical Plan Preventive Schedule in pdf format.
2017 GOLD HSA (HEALTH SAVINGS ACCOUNT) OPTION
Click here for information about the Gold HSA Plan, our high-deductible health plan/health savings account (HDHP/HSA) option.
Click here for a handy quickstart guide to starting an HSA.
NOTICE OF PRIVACY PRACTICE
Click here to download the most recent Notice of Privacy Practice in pdf format.
PRESCRIPTION PLAN MAIL ORDER INFORMATION
Click here for information about our Prescription Plan mail order service.
CREDITABLE COVERAGE LETTER
Click here to download the Creditable Coverage Letter regarding prescription drug coverage and Medicare.
HEALTH REIMBURSEMENT ARRANGEMENT (HRA) PLAN DOCUMENT
Click here to download the HRA Plan Document. Please note that if a church is providing any kind of medical reimbursement, it is required to have an HRA in place. The Plan (and document) is provided by the EPC for the benefit of individual EPC churches and is not an EPC Plan.
HEALTH REIMBURSEMENT ARRANGEMENT (HRA) ADOPTION AGREEMENT
Click here to download the HRA Adoption Agreement document that can be used if you choose to utilize this Plan.
HEALTH REIMBURSEMENT ARRANGEMENT (HRA) FAQ
Click here to download answers to common questions about an HRA and this Plan.
DENTAL PLAN BOOKLETS
These booklets highlight the benefits provided under the EPC Dental Plans and provide both quick access to the information you will most often want to review, and detailed explanation of your benefits and any limitations or restrictions that might apply.
Click here to download the Low Plan booklet.
Click here to download the High Plan booklet.
TERM LIFE AND AD&D PLAN HANDBOOK
Click here to download the Term Life and AD&D Plan Handbook, provided by Hartford Life and Accident Insurance Company.
LONG-TERM DISABILITY PLAN HANDBOOK
Click here to download the Long-Term Disability Plan Handbook, provided by Hartford Life and Accident Insurance Company.
RETIREMENT FORMS AND NOTICES
DEFINED RETIREMENT CONTRIBUTION PLAN
Click here to download the terms and conditions that apply with respect to assets held in the Code Section 403(b)(9) retirement income account program.
RETIREMENT PLAN INVESTMENT POLICY STATEMENT
Click here to download an outline of general investment policies as adopted by the Board of Benefits in December 2016. This document provides guidance to the investment advisory firm in determining and implementing investment decisions.
Information provided in this web site does not constitute legally binding advice. EPC benefits are subject to the provisions of the Wrap, Medical Plan, and Retirement Plan documents available on this website or in print from EPC Benefits, P.O. Box 6412, Plymouth, MI 48170. For more information, contact EPC Benefits at (734) 838-6942 or fax (734) 742-2034.
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