Forms and Summaries – Belmont Academy

Claim Forms & Plan Summaries

The documentation for each of your benefit offerings is included below.

Click on any of the categories to see the available forms and information.

Medical

Virtual Visits Guideen Virtual Visits Guidees

Dental

Member Resourcesen Member Resourceses

Vision

Vision Benefit Summaryen Vision Benefit Summaryes Frequently Asked Questions (FAQs)en Frequently Asked Questions (FAQs)es

Prescription

Prescription Discount Carden Prescription Discount Cardes

Spending Accounts (HSA/FSA)

HSA Spending Account Detailsen HSA Spending Account Detailses FSA Spending Account Detailsen FSA Spending Account Detailses DCAP Spending Account Detailsen DCAP Spending Account Detailses

Basic Life AD&D

Basic Life Benefit Summaryen Basic Life Benefit Summaryes

Voluntary Life AD&D

Voluntary Life Benefit Summary en Voluntary Life Benefit Summary es

Life + Care Insurance

Life + Care Benefit Summaryen Life + Care Benefit Summaryes

Short-Term Disability

Short-Term Disability Benefit Summary en Short-Term Disability Benefit Summary es

Long-Term Disability

Long-Term Disability Benefit Summaryen Long-Term Disability Benefit Summaryes

Accident

Accident Benefit Summaryen Accident Benefit Summaryes Wellness Benefit Guideen Wellness Benefit Guidees

Cancer

Cancer Benefit Summaryen Cancer Benefit Summaryes

Critical Illness

Critical Illness Benefit Guideen Critical Illness Benefit Guidees How to File a Claimen How to File a Claimes

Hospital Indemnity

Enrollment Guideen Enrollment Guidees How to File a Claimen How to File a Claimes

My Financial Expert

Premium Plan Benefit Summaryen Premium Plan Benefit Summaryes Elite Plan Benefit Summaryen Elite Plan Benefit Summaryes

Ambulance Coverage

Ambulance Summaryen Ambulance Summaryes

Dependent Care FSA

Dependent Care FSA Summaryen Dependent Care FSA Summaryes

Pet Insurance

Plan Summaryen Plan Summaryes

Employee Assistance Program

EAP Benefit Guideen EAP Benefit Guidees Frequently Asked Questions (FAQs)en Frequently Asked Questions (FAQs)es

Employee Documents & Notices

Workplace Conduct & Ethics Noticeen Workplace Conduct & Ethics Noticees