Providing Guidance and Commitment to our employees

The Benefits Section administers the various benefit plans of the Medical College of Georgia and communicates pertinent information concerning those plans. The Benefits staff:

• Processes benefit enrollment applications and requests for changes in coverage
• Communicates information to employees, retirees, and COBRA participants concerning changes in benefit plans
• Provides an overview of each benefit plan to new employees during biweekly employee orientation sessions
• Administer the Workers Compensation program
• Processes life insurance claims
• Provides verification of insurance coverage for employees, retirees and COBRA participants
• Provides counseling on retirement plans/options
• Processes applications for retirement plans
• Provides information on tax sheltered annuities and deferred compensation plans
• Administers Leave of Absence, FMLA, Military, Education and Personal leave plans

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PLAN YEAR 2009

2009 Plan Information

• Benefit Plan Summary (2009)
• HDHP/HSA-PPO Plan Document
• HMO/HMO Choice Plan Document
• Regents Dental (MetLife) Plan Document
• Delta Dental Plan Document
• COBRA Benefits Premium/Plan Summary
• Flexible Spending Account Plan Document
• Tax Sheltered Annuity & Deferred Compensation Plan Summary
• Benefits information for terminating employees and employees with

          reduction in work commitment

• Indemnity/PPO Prescription Plan (Medco) www.medco.com/openenroll  Access Code: BORRXPLN14383

2009 Frequently Requested Forms

You may return the completed forms, along with any necessary supporting documentation, to the Benefits Department in the Annex I Building, west entrance, or fax to 706-721-1572.

• AFLAC  Authorization Form
• AFLAC Cancer Claim Form
• AFLAC Disability Continuation Form
• AFLAC Accident or Injury Form
• AFLAC Sickness or Pregnancy Form

• COBRA Application

• Flexible Spending Account Claim Form
• Flexible Spending Account Enrollment Form

• Health Savings Account (HSA) Enrollment Form

• Hartford Life Beneficiary Change Form
• Hartford AD&D Beneficiary Form
• Outstanding Wages Beneficiary Designation Form

• HMO Certification of Dependency Form
• Blue Cross/Blue Shield Incapacitated Dependent Form

• Insurance Enrollment Form
• Insurance Change Request Form (Active Employee)
• Insurance Change Request Form (Retiree)

• MCG 403(b) Salary Reduction Agreement Form
• MCG 457(b) Salary Reduction Agreement Form

• MEDCO Direct Claim Form

• Worker's Compensation Incident Only Form
• Worker's Compensation Employee Report of Accident/Injury Form
• Worker's Compensation Leave Election Form

Family Medical Leave Act forms:

• Certification of Health Care Provider for Employee's Serious Health Condition
• Ceritfication of Health Care Provider for Family Member's Serious Health Condition
• Notice of Eligibility and Rights & Responsibilities
• Designation Notice
• Certification of Qualifying Exigency For Military Family Leave
• Certification of Serious Injury or Illness of Covered Servicemember (for Military Family Leave)
• FMLA Return to Work Form
• Request for FMLA Form