Forms & Documents

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Forms (Participants)

100 Benefit Plan Enrollment Application Packet (LTD & Life/AD&D Insurance)

Benefit Plan Enrollment Application Packet for Long Term Disability & Life/AD&D Insurance - for coverage starting January 2020 or after. Contains all forms for enrollment (101, Limitations & Exclusions, 102, 103, 138).
Filename: 100 - Benefit Enrollment Application FILLABLE - 11152019.pdf
Size: 662 KB
Forms (Participants)

102 Benefit Plan Beneficiary Designation Form for Life/AD&D Insurance

Form to UPDATE beneficiary information for Life/AD&D Insurance.
Filename: 102 - Beneficiary Designation FILLABLE - 09132019.pdf
Size: 418 KB
Forms (Participants)

103 Benefit Plan Salary Worksheet for LTD

Form to UPDATE salary information for LTD insurance
Filename: 103 - Salary Worksheet FILLABLE - 11152019.pdf
Size: 244 KB
Forms (Churches/Employers)

104 Benefit Plan Employee Payment Method and Coverage Update

Form to notify employee(s) of change in Benefit Plan (LTD & Life/AD&D Insurance) payment method and/or coverage
Filename: 104 - Employee Payment Method & Coverage Update FILLABLE - 11152019.pdf
Size: 284 KB
Forms (Churches/Employers), Information

120 Benefit Plan Employer Agreement for LTD & Life/AD&D Insurance

Benefit Plan (LTD & Life/AD&D insurance) adoption agreement for employer.
Filename: 120 - Employer Benefit Agreement FILLABLE - 11152019.pdf
Size: 327 KB
Forms (Churches/Employers), Information

121 Benefit Plan Employer Guide (LTD & Life/AD&D Insurance)

Contains helpful resources for a treasurer, bookkeeper, executive pastor, or administrator to understand the Benefit Plan (LTD & Life/AD&D Insurance), and the employer’s responsibility. This guide contains information regarding coverage, form descriptions, completing the Employer Benefit Agreement, employee enrollments, premium costs and payment methods, and more.
Filename: 121 - Benefit Plan Employer Guide - 2202.pdf
Size: 2833 KB
Forms, Information

130 Benefit Plan - LTD Insurance Contract

Insurance contract for the FCMM Benefit Plan's Long Term Disability Insurance from Unum.
Filename: 130 Benefit Plan - LTD Insurance Contract 2010.pdf
Size: 352 KB

135 Benefit Plan - How to File a Long Term Disability Claim

Steps to follow when filing a claim for Long Term Disability benefit.
Filename: 135 How to File a Long Term Disability Claim 2101.pdf
Size: 160 KB
Forms, Information

138 Benefit Plan Coverage Overview (LTD & Life/AD&D Insurance)

Summary of Benefit Plan Coverage for Long Term Disability and Life/AD&D Insurance
Filename: 138 - Coverage Overview 1909.pdf
Size: 214 KB
Forms (Participants), Information

150 FCMM Benefit Plan Employee Welcome

Information for an employee newly enrolled in the FCMM Benefit Plan (LTD/Life/AD&D Insurance)
Filename: 150 - Benefit Plan Employee Welcome Packet - 2101.pdf
Size: 2662 KB

Sample: Salary Continuation Plan Policy

A Sample Salary Continuation Policy for Self-Funded Short-Term Disability Benefits
Filename: Salary Continuation Policy SAMPLE 2017.pdf
Size: 23 KB

Sample: Salary Continuation Plan Resolution

A sample Salary Continuation Plan Resolution and Employee Notification Letter.
Filename: Salary Continuation Plan SAMPLE resolution & EE notice.pdf
Size: 540 KB
Forms, Information, Brochures

FCMM Benefit Plan Brochure

Benefits | Features | Cost | Premium Method
Filename: 20210323_FCMMBrochure_BenefitPlan (web).pdf
Size: 289 KB
Forms (Participants), Information

33 Privacy Notice

Description of FCMM's policy and practices for collection and security of participant data.
Filename: 33 FCMM Privacy Notice 1805.pdf
Size: 92 KB