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Benefit Plan Information and Forms Select a document from the menu tree below. All forms require the Adobe Acrobat Reader. 2011-2012 Benefit Guide 2012 - 2013 Benefit Guide 2012-2013 Hitchcock ISD Benefit Guide Medical 2012 - 2013 Plan Year TRS Enrollment Video - English TRS Enrollment Video - Spanish TRS-Active Care Highlights Provider Search TRS Active Care Home Page 2011 - 2012 Plan Year TRS-Active Care Enrollment Guide (English) TRS-Active Care Enrollment Guide (Spanish) PPO Rates and Benefits HMO Rates and Benefits Dental 2012 - 2013 Plan Year Cigna PPO Plan Cigna Claim Form Cigna Provider Search Hitchcock Only MetLife DHMO Rates 2011 - 2012 Plan Year MetLife PPO Plan MetLife Claim Form MetLife Provider Search Vision Block Vision Plan Summary Claim Form Provider Search Print Temporary ID Card Disability 2012 - 2013 Plan Year Hartford Disability Plan Summary and Rates How to File a Claim Hartford EAP Brochure 2011 - 2012 Plan Year Unum Disability Plan Summary Select Disability Claim Form Medical Treatment Form Life Balance (EAP) EAP Brochure Unum Home Page Life 2012 - 2013 Plan Year Dearborn Term Life Plan Summary and Rates Evidence of Insurability Form Claim Form Online Will Benefit Resources Travel Assistant Portability vs. Conversion Chart Portability Application Conversion Application 2011 - 2012 Plan Year UNUM Term Life Plan Summary 2011 - 2012 Life Rates 2011 - 2012 Portability vs. Conversion Comparison Conversion Form Portability Form Evidence of Insurability Claim Form Unum Home Page Individual Life PureLife-Plus Plan Highlights Application Cancer 2012 - 2013 Plan Year Loyal American Cancer Plan Summary and Rates Cancer Claim Form Wellness Claim Form 2011 - 2012 Plan Year Rates Plan Brochure Diagnostic Testing Claim Claim Form Instructions APL Home Page Critical Illness UNUM Critical Illness Plan Summary Full Benefit Detail UNUM - Critical Illness (Video) Claim Form Wellness Claim Form Full Benefit Detail Exclusions Page AE-1068 Important Notice to Persons on Medicare VB-348 Medicare Guide LTC-164 Accident APL Plan Summary Claim Form Identity Theft ID Watchdog Plan Summary Reimbursement Accounts 2012 - 2013 Plan Year NBS Brochure 2011 - 2012 Plan Year HIPAA Notice Direct Deposit Authorization Web Instructions Health Care Reimbursement Claim Form Orthodontic Continuation Form Dependent Care Continuation Form Dependent Care Reimbursement Claim Form NBS Forms Website NBS Home Page 403 (b) Salary Reduction Agreement NBS Homepage Admin Forms 2011 Enrollment Form 2012-2013 Enrollment Form		Enrollment Links Employee Login Enrollment Instructions Administrator Login Quick Links > John Ledebur 972-977-4722 Financial Benefit Services, LLC John Ledebur 972-977-4722 2121 N. Glenville Drive Richardson, TX 75082 Local: (469) 385-4640 Toll Free: (800) 583-6908 Fax: (469) 385-4641
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