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.

Affordable Care Act Marketplace Notice

Benefits Documents:

2022 Annual Member Notice

Benefits for FT – PT Employees 7-22

Diocese of Charlotte Privacy Notice – updated 2013

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

HealthEquity

HFSA Pay Me Back Form

HealthEquity HSA Contribution Form

 

Saving for Retirement:

Understanding your 403(b) Retirement Savings Plan

 

Workers’ Compensation:

WHEN AN ACCIDENT HAPPENS AT WORK

Treatment Authorization for Injured Worker

Workers Comp Contact Information

 

For Administrators:

Enrollment Info – New Benefit Eligible Lay Employee

Continuation Letter for locations

Continuation Insurance Election Form