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:

2019 United Healthcare Annual Member Notice

Benefits for FT and PT Employees

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

Benefitfocus Account Services:

Benefitfocus-FSA Reimbursement Request Form

Benefitfocus-HSA Distribution Request Account Closure Form

 

Saving for Retirement:

Understanding your 403(b) Retirement Savings Plan

 

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