Forms & Documents

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To securely send a form with personal information to FCMM, please use our secure file exchange portal.

Long Term Disability Insurance Plan Information

Forms (Participants)

101 Long Term Disability Enrollment

Long Term Disability Enrollment Form & Packet for employee completion
Filename: 101 FCMM LTD Enrollment Packet Fillable-012018.pdf
Size: 750 KB
Forms (Participants)

102 LTD Beneficiary Designation Form - Term Life & AD&D

Long Term Disability Insurance Participants: use this form to update beneficiary for your Term Life and AD&D coverage. (For initial enrollment, this form is included in Form 101 Enrollment Packet.)
Filename: 102 FCMM Beneficiary Designation for Life Ins 201406.pdf
Size: 98 KB
Forms (Participants)

103 LTD Salary Worksheet & Information Change

Form to Update Salary for Long Term Disability Insurance. (For initial enrollment, this worksheet is included in Form 101 Enrollment Packet.)
Filename: 103 FCMM LTD Salary worksheet 201503.pdf
Size: 40 KB
Forms (Churches/Employers), Information

120 Long Term Disability Employer Information

Group long term disability insurance plan Church Board Packet with resolution and adoption information. Each employee completes Form 101 Enrollment Packet.
Filename: 120 FCMM LTD Church Board 012018.pdf
Size: 48 KB
Forms (Churches/Employers), Information

138 LTD Coverage Overview

Summary of Long Term Disability and Term Life & AD&D Insurance Plan Coverage
Filename: 138 Coverage Overview LTD and Life 201801.pdf
Size: 50 KB
Information

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
Information

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, Brochures

FCMM Long Term Disability Plan Brochure

Benefits | Features | Cost | Benefit or Payroll Deduction?
Filename: 20180101 FCMMBrochure_LTDPlan (web).pdf
Size: 302 KB