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 Forms:

2016 UHC Annual Member Notice

Employee Benefits Summary for Full-Time Employees

Employee Benefits Summary for Part-Time Employees

Diocese of Charlotte Privacy Notice – updated 2013

Summary of Benefits & Coverage

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

2016-17 DOC Health Screening Voucher Form

2016-17 Online Health Assessment Voucher Form

Medical, Dental, Vision:

UnitedHealthcare Medical Claim Form

UnitedHealthcare Dental Claim Form

UnitedHealthcare Vision Claim Form

HIPAA Authorization Form

Prescriptions:

Caremark Prescription Mail Order Form

Caremark Prescription Reimbursement Claim Form

Flexible Spending Account:

Health Care FSA Claim Form

Lay Retirement:

Lay Retirement Beneficiary Designation Form

 

Workers’ Compensation:

When An Accident Happens At Work Poster

 

For Administrators:

Insurance Continuation Letter

Continuation Insurance Election Form

STD Notification and Waiver Form

Long Term Care Notification and Waiver Form