Documents & Forms
Flexible Benefit Plan
- Annual Salary Reduction Agreement
- Dependent Care Reimbursement Account Reimbursement Form
- Flexible Spending Account Reimbursement Form
Lay Employees' Retirement Plan
- Direct Deposit Form
- Federal Tax Withholding Form
- LERP Beneficiary Designation Form for Plan Death Benefit
- Michigan Tax Withholding Form
- Michigan Tax Withholding Worksheet
- Request for Pension Estimate
- Request for Retirement Application Kit
Legally Domiciled Adult
Life Insurance
- Life and Accidental Death & Dismemberment Insurance Beneficiary Designation Form
- UNUM Voluntary Term Life Insurance Beneficiary Designation Form
- Printable UNUM Voluntary Term Life Insurance Evidence of Insurability Form
- Online UNUM Voluntary Term Life Insurance Evidence of Insurability Form
- Instructions for Online UNUM Voluntary Term Life Insurance Evidence of Insurability Form
Long Term Disability Plan
MCC 403(b) Retirement Savings Plan
Medical, Dental, and Vision Plans
- Authorization for Release of Protected Health Information
- BCBSM Member Reimbursement Claim Form
- BCBSM Prescription Drug Reimbursement Claim Form
- BCN Member Reimbursement Claim Form
- BCN Prescription Drug Reimbursement Claim Form
- Delta Dental Out of Network Claim Form
- Notice of Creditable Prescription Drug Coverage
- VSP Out of Network Claim Form
Short Term Disability Plan
- Form W-4 (Federal Tax Withholding Form)
- Form MI-W4 (Michigan Tax Withholding Form)
- Short Term Disability Authorization Agreement Electronic Funds Transfer
- Short Term Disability Application
- Short Term Disability Continuing Disability Statement
Unit Benefit Changes
New Hire/Newly Eligible Employee Enrollment Guide
The “New Hire/Newly Eligible Employee Enrollment Guide” can now be found on the “New Hires/Newly Eligible Employees” page.