Skip to content
  • New Hires
  • Employee Assistance Program
  • Forms
  • Health
    • Medical
    • Dental
    • Vision
  • Flexible Spending
    • Medical Flexible Spending
    • Dependent Care Flex Spending
  • Disability Leave
    • Short Term Disability
    • Long Term Disability
  • Life
    • Employer Paid
    • Supplemental
    • Individual Whole Life Insurance
  • Other
    • Critical Illness / Cancer
    • Genomic Life

Forms

  1. Home
  2. Calhoun City Schools
  3. Forms
Formshinata2023-08-15T18:12:20+00:00
  • Medical
  • Dental
  • Vision
  • Flexible Spending
  • Group Life
  • Short Term Disability
  • Long Term Disability
  • Critical Illness
  • Whole Life
  • Genomic Life
  • Medical

Medical / SHBP

  • All enrollments/changes must be made through the
    • ADP Enrollment Portal
  • Dental

Dental – Delta

  • Claim Form
  • Vision

Vision – Spectera / United Healthcare

  • Statement of Dependent Eligibility
  • Flexible Spending

Flexible Spending – Consolidated Admin Solutions

  • Medical Claim Form
  • Change Status Form
  • Card Request Form
  • Group Life

Group Life – Lincoln Financial

  • Beneficiary Designation Form
  • Claim Form or Dependent Claim
  • Voluntary Life Portability Application
  • Conversion Form
  • Basic Life Continuation Application
  • Evidence of Insurability (EOI) Form
  • Waiver of Life Premium (Totally Disabled)
  • Short Term Disability

Short Term Disability – Lincoln Financial

  • Employee Claim Form
  • Employer Statement
  • Attending Physician Statement
  • Combined Employee, Employer, Physician Statement
  • Long Term Disability

Long Term Disability – Lincoln Financial

  • Employee Claim
  • Employer Statement
  • Attending Physician Statement
  • Combined Employee, Employer, Physician Statement
  • Critical Illness

Critical Illness – Unum

  • Beneficiary Designation Form
  • Claim Form
  • Port Request when Terminating Employment and Port Brochure for additional information
  • Whole Life

Whole Life – Unum

  • Beneficiary Change Form
  • Claim Form
  • Genomic Life

Genomic Life

  • Continuation Form

Contact Us With Questions

We are here to assist with your Benefits needs. Call us with any questions or concerns at our toll-free number, 800.523.7135 or email us at enrollment@houze.org.

Benefits Contact

Myra Ingle
HR Accounting Assistant
(706) 602-6612
inglem@calhounschools.org

Summary of Benefits

Click below to download and review a Summary of Benefits document (.pdf).

Summary of Benefits

© Houze & Associates| 308 Church Street | PO Box 3070 | LaGrange, GA 30240

Page load link
Go to Top