Forms & Documents
Forms (Participants)
100 Benefit Plan Enrollment Application Packet
This form is required for newly eligible employees enrolling in either the Standard Plan (LTD & Life/AD&D Insurance) or Plus Plan (STD, LTD, & Life/AD&D Insurance). Packet includes 101, Limitations & Exclusions, 102, 103, and 138.
101 Benefit Plan Enrollment Application
Included in the Enrollment Application Packet (Form 100). [Basic enrollment form; original enrollment is incomplete without Forms 102 and 103.]
Forms (Participants)
102 Benefit Plan Beneficiary Designation
Included in the Enrollment Application Packet (Form 100) and can be used to update beneficiary information, which affects the LTD survivor benefit and Life/AD&D insurance. As required by the insurance carrier, the original, hard copy of this form must be mailed to FCMM.
103 Benefit Plan Salary Worksheet
Included in the Enrollment Application Packet (Form 100) and can be used to update salary information, which affects disability premiums and benefit amount.
Forms (Churches/Employers)
104 Benefit Plan Application Addendum for Updates
This form can only be completed during the annual open enrollment period after an employer updates their Employer Benefit Agreement (Form 120). Employees receiving a change to their benefits must complete this form.
Forms (Churches/Employers)
, Information
120 Benefit Plan Employer Agreement
New employers to the Benefit Plan must complete this form upon initially entering the plan. Current employers can only updated benefits and coverage during the annual open enrollment period by completing this form. The form details two benefit plan options, employee eligibility, payment methods, and Life/AD&D coverage amounts.
Forms (Churches/Employers)
, Information
121 Benefit Plan Employer Guide
Contains helpful resources for whomever is administering the Benefit Plan at an organization. The guide contains information regarding coverage highlights, form descriptions, how to complete the Employer Benefit Agreement, premium amounts, payment method descriptions, paying invoice online, and frequently asked questions.
Forms (Participants)
, Forms (Churches/Employers)
135 Benefit Plan - How to File a Claim
Steps to follow when filing a claim for the Benefit Plan
Forms (Participants)
, Information
138 Benefit Plan Coverage Overview
Summary of Benefit Plan coverage for Short Term Disability, Long Term Disability, and Life with Accidental Death and Dismemberment Insurance.
Forms (Participants)
, Information
150 Benefit Plan Employee Welcome Packet
Contains helpful resources for newly enrolled employees in the Benefit Plan. The welcome packet contains information regarding coverage highlights, premium rates, and frequently asked questions.
Information
Sample: Salary Continuation Plan Policy
A Sample Salary Continuation Policy for Self-Funded Short-Term Disability Benefits
Information
Sample: Salary Continuation Plan Resolution
A sample Salary Continuation Plan Resolution and Employee Notification Letter.
Forms (Participants)
, Forms (Churches/Employers)
, Information
, Brochures
FCMM Benefit Plan Brochure
Benefits | Features | Rates | Payment Methods
Forms (Participants)
, Information
33 Privacy Notice
Description of FCMM's policy and practices for collection and security of participant data.
