Forms & Documents

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Long Term Disability & Life/AD&D Insurance Benefit Plan Information

Forms (Participants)

101 Long Term Disability Enrollment - for 2019 ONLY

2019 Enrollment ONLY: Long Term Disability Enrollment Form & Packet for employee completion.
Filename: 101 LTD Full Enrollment Packet Fillable-11262018.pdf
Size: 951 KB
Forms (Participants)

103 LTD Salary Worksheet & Information Change - for 2019 ONLY

2019 ONLY: Form to Update Salary for Long Term Disability Insurance. (For initial enrollment, this worksheet is included in Form 101 Enrollment Packet.)
Filename: 103 LTD Salary Worksheet-11262018.pdf
Size: 162 KB
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 - 09132019.pdf
Size: 678 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 - 09132019.pdf
Size: 303 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 - 09132019.pdf
Size: 603 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 - 09132019.pdf
Size: 517 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 - 09132019.pdf
Size: 360 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 Employer Guide.pdf
Size: 5008 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, Information, Brochures

FCMM Long Term Disability Plan Brochure (through 2019)

Benefits | Features | Cost | Benefit or Payroll Deduction? New Brochure Pending for 2020
Filename: 20180101 FCMMBrochure_LTDPlan (web).pdf
Size: 302 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