Employee Benefits Information

The Diocese of Charlotte offers a range of benefit programs to assist employees in caring for themselves and their families. The Human Resources Office administers these programs.

New Health Insurance Marketplace Coverage Options and Your Health Coverage

Benefits Documents:

2018 UnitedHealthcare Annual Member Notice

Benefits for FT & PT Employees 7-18

Diocese of Charlotte Privacy Notice – updated 2013

Summary of Benefits & Coverage

Ability Assist – Resources to help employees cope with life’s challenges

Medical, Dental, Vision:

UnitedHealthcare Medical Claim Form

Delta Dental Claim Form

Eye Med Out-of-Network Claim Form

HIPAA Authorization Form

Prescriptions:

Caremark Prescription Mail Order Form

Caremark Prescription Reimbursement Claim Form

Discovery Benefits:

FSA Out-of-Pocket Reimbursement Request Form

Health Savings Account (HSA) Distribution Request Account Closure Form

 

Lay Retirement:

Lay Retirement Beneficiary Designation Form

 

Workers’ Compensation:

When An Accident Happens At Work Poster

 

For Administrators:

Enrollment Info – New Benefit Eligible Lay Employee

Continuation Letter for Locations

Continuation Insurance Election Form