Documents & Forms

Flexible Benefit Plan

• Annual Salary Reduction Agreement
• Flexible Benefit Reimbursement Form
• Meritain Direct Deposit Authorization Form

Lay Employees' Retirement Plan

• Direct Deposit Form
• Federal Tax Withholding Form
• LERP Beneficiary Designation Form for Plan Death Benefit
• Michigan Tax Withholding Form
• Request for Pension Estimate
• Request for Retirement Application Kit

Life Insurance

• Life and Accidental Death & Dismemberment Insurance Beneficiary Designation Form
• UNUM Voluntary Term Life Insurance Beneficiary Designation Form

Long Term Disability Plan

• LTD Claim Form

MCC 403(b) Retirement Savings Plan

• 403(b) Beneficiary Designation Form
• 403(b) Salary Reduction Agreement

Medical and Dental Plans

• Authorization for Release of PHI
• Legally Domiciled Adult Certification Form
• Legally Domiciled Adult Decertification 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

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.