Coastal States Bank Benefit Information
Welcome to your employee benefit portal. If you have any questions with the below information please contact your HR department or Michael Wolfe. Thank you!
2019 Enrollment Guide
BlueCross BlueShield-Medical
- Summary of Benefits & Coverage – PPO Plan
- Summary of Benefits & Coverage – HDHP Plan
- PPO Plan Benefit Summary
- High Deductible Health Plan Benefit Summary
- Health Incentive Account Flyer – PPO Plan
- Health Incentive Account Flyer – HDHP Plan
- BCBS Health Insurance Claim Form
- BCBS Prescription Drug Claim Form
- Prescription Drug Mail Order Form
- Preferred Drug List
- Prior Authorization Drug List
- Quantity Management Drug List
- Specialty Drug List
- Step Therapy Drug List
- Healthy Incentive Account Flyer
- Blue Care on Demand
MetLife-Dental
Mutual of Omaha-Disability & Life
- Voluntary Short Term Disability Benefit Summary
- Short Term Disability Claim Form
- Long Term Disability Insurance Benefit Summary – All Other Employees
- Long Term Disability Insurance Claim Form
- Disability Authorization to Disclose Personal Information Form
- Company Paid Basic Life Insurance Benefit Summary – Executive Class
- Company Paid Basic Life Insurance Benefit Summary – All Other Employees
- Voluntary Life Insurance Portability Request Form
- Basic Life Insurance Conversion Form
- Employee Assistance Program Brochure
VSP-Vision
Medicare
Compliance Documents
- CHIPRA Notice
- COBRA Event Notice Procedures & Form
- ERISA Notice
- HIPAA Certificate of Creditable Coverage
- HIPAA Notice of Privacy Practices
- HIPAA Special Enrollment Notice
- WHCRA Notice
- Summary Annual Report
- Summary Plan Description
- Patient Protection Choice of Providers
- Wellness Program Notice