Enrollment, Change, Termination and Claim Forms

Please see your benefits administrator at your parish/school/office/agency regarding any benefit changes first for eligibility. If you are eligible for an enrollment, change, or termination, all completed forms need to be submitted to your benefits administrator.

Health Insurance Form for Medical, RX and Dental coverage

The Wellness Incentive Program for the 2016 - 2017 Plan Year.

Flexible Spending Account (FSA) Forms

Retirement Forms

Long Term Disability Forms

Hartford Life Insurance Forms


Please see the 2015 -2016 Benefits Administration Manual below:

               Archdiocese of St. Louis Benefits Administration Manual 2015 -2016