H.R. Forms

Evidence of Insurability Form for USAble Life.

Principle life insurance form that you can fill out online.

Principal Financial Short Term Disability Summary Plan Description Document

Principal Financial Long Term Disability Summary Plan Description Document

Prudential Enrollment Form 403(b). NOTE: Original MUST be returned to HR Office/Benefits Manager. • Once you see the deduction on your payroll, you can change your contribution by going to Self Service / Benefits / Benefits Summary / Scroll down to Retirement Savings and click / Click Edit on the next screen and change your election / You can do a flat dollar amount or a percent. You cannot stop your deduction here; that requires a paper form.

Prudential 457(b) Non-Qualified Enrollment Form

Erlanger Benefits Flyer 457 Plan

Authorization to deduct a specified amount from your paycheck for medical services provided.

In the event on an on-the-job injury, fill out this form and report incident to the supervisor/department head within 24 hours of the incident, or knowledge of exposure. In the absence of the immediate supervisor or department head, the employee should report the injury to the Administrative Representative on duty.