Forms & Documents

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

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, Brochures

FCMM Long Term Disability Plan Brochure

Benefits | Features | Cost | Benefit or Payroll Deduction?
Filename: 201512 FCMMBrochure_LTDPlan (web).pdf
Size: 200 KB