Carolina Health Centers Model Notices and Employee Documents
This webpage houses all of the Carolina Health Centers’ model notices along with your Employee Benefits Summary Plan Description for the 2018 benefit year that starts on January 1, 2019. Also, on this page are each carriers certificate of coverage for your benefit. We have also included summaries of these documents for your review along with some carrier forms below. If you need any more information please contact Human Resources or your Clarke & Company Benefits representative below.
Click here to access your online enrollment!
Enrollment Materials
BlueCross & BlueShield
- Basic Plan Summary of Benefits & Coverage
- Enhanced Plan Summary of Benefits & Coverage
- Health Insurance Claim Form
- HIA Flyer-1500
- HIA Flyer-2500
- Mail Service Order Form
- Prescription Drug Claim Form
- Click here to visit BlueCross & BlueShield of SC’s website
Delta Dental
- Claim Form
- PPO Network Provider Search 30 Miles
- Premier Network Provider Search 30 Miles
- Schedule of Benefits
- Summary Plan Description
- Click here to visit Delta Dental’s website
Standard
- Evidence of Insurability
- Life Insurance Claim Form
- Life Insurance Conversion Form
- Life Insurance Portability Form
- Life Insurance Waiver of Premium Packet
- Long-Term Disability Claim Packet
- Short Term- Disability Claim Packet
- Emergency Medical Travel Assistance Program (Employee)
- Travel Assistance Program Flyer
- Employee Assistance Program
- Group Basic Life Insurance Certificate (Mgmt, Providers, Pharmacists)
- Group Life Insurance Certificate (All Other Members)
- Group Basic Life Insurance Policy
- Long-Term Disability Certificate (Mgmt, Providers, Pharmacists)
- Long-Term Disability Certificate (All Other Members)
- Long-Term Disability Policy
- Long-Term Disability SPD (Mgmt, Providers, Pharmacists)
- Short-Term Disability Certificate (Mgmt, Providers, Pharmacists)
- Short-Term Disability Certificate (All Other Members)
- Short-Term Disability Policy
Physicians Eyecare Plan
Pro Benefits Flex Information
- Claims Guidebook
- Dependent Care Receipt Form
- Enrollment Guide
- Letter of Medical Necessity
- Reimbursable Expenses
- Reimbursement Claim Form
Compliance Documents
- CHIPRA Notice
- HIPAA Certificate of Credible Coverage
- HIPAA Notice of Privacy Practices
- HIPAA Special Enrollment Notice
- WHCRA Document
- Medicare Part D Notice
Web Tools For Managing Your Health
BlueCross & BlueShield My Health Toolkit
As an employee of Carolina Health Centers, take charge of your health and start using the My Health Toolkit from BlueCross. Watch a short video on how you can check your Explanation of Benefits, take a Personal Health Assessment, check claim status, find a doctor, see what has been applied to your deductible and much more. In the video, you will learn everything in the new toolkit and how you access it. Please note that the video is on Blue Cross of SC but you’re my Health Toolkit is the exact same for BlueChoice of SC.
To view a video on the My Health Toolkit web tool click below.
My Health Toolkit Video
Questions About Carolina Health Centers’ Benefits
If you have any questions concerning your current benefit package, any future benefits, or any other benefit information that you may need, please contact our benefit team at Clarke & Company Benefits. Our contact information is below.
Laura Howell – Account Manager
Toll Free: 888-540-9403
Columbia: 803-253-6997
To email click on name above.