Flexible Benefits Program Materials Order Form

Booklets/Brochures

Quantity Ordered

Enrollment Booklets

Life Booklets* - Vendor will send booklets to open enrollment enrollees

Disability Booklets* - Vendor will send booklets to open enrollment enrollees

Dental Regular & PPO Booklets - Vendor will send booklets to open enrollment & new hire enrollees

Dental Prepaid Booklets - Vendor will send booklets to open enrollment & new hire enrollees

Legal Booklets - Vendor will send booklets to open enrollment & new hire enrollees

Long Term Care Enrollment Kits (Unum)

Vision Brochure* - Vendor will send booklets to open enrollment enrollees

Spending Account Booklets - Vendor will send booklets to open enrollment enrollees

Forms

Quantity Ordered

Minnesota Life Medical Underwriting Form (Life)

Minnesota Life Group Term Employee Life, Dependent Life and Employee Accidental Death Claim Form

Standard Medical Underwriting Form (Disability)

Standard Disability Claim Form

Specified Illness Benefits Form

Specified Illness Claim Form

Specified Illness Application Form

Flexible Spending Account Claim Forms – Call SHPS toll- free at 1-800-893-0763. Please specify State of Georgia Flexible Spending Account forms.

Dental Claim Forms (Regular & PPO options only) – Call United Concordia toll-free at 1-866-215-2356 (please specify State of Georgia Dental forms) or print from the SPA website: http://www.spa.ga.gov (click on Flexible Benefits)

Contact Information

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