Enrollment & State Health

• 2025-2026 Benefits Worksheet
• SHBP Worksheet for NEW HIRES Only
• Avesis Vision Enrollment Form
• SHBP Retirement/Surviving Spouse Form
• Other SHBP Forms

• Evidence of Insurability Form – Voya/Reliastar Life

• MedCom Forms Library
• MedCom In Home Day Care Receipt
• MedCom Flex Dependent Card Request Form
• MedCom Flex Direct Deposit Form
• MedCom Flex Family Status Change Form

• Whole Life Applications – Voya
• Whole Life Rates – Voya
• Leave Bank Withdrawal Request Form
• Leave Bank Physician’s Statement
• Cancer Enrollment Form– New Hires/Guarantee Issue- The Standard
• Cancer Application– includes EOI- The standard

Voya Group Number 362395

Claim Forms Library – Voya
Online Claim Form – Voya
Wellness Claim – Voya

Disability Claims must submit 3 Claims:

• Claim for the Employee- Employee Completed
• Claim for the Employer- Employer Completed
• Claim for the Physician- Physician Completed

• Group Life Death Claim – Voya
• Individual Life Death Claim – Voya
  • Initiate a claim: 800-537-5024 with Obituary and the claim will be fully processed when a death certificate is submitted
• Accident Claim Instructions – Voya/ING Group Accident
• Wellness Critical Illness – Voya/ING (Grandfathered Plan)
• Cancer Claim Form – Standard (formerly AllState)
• Cancer Wellness Benefit Claim Form – Standard (formerly AllState)
• Critical Illness Claim Form– Standard (formerly AllState)
• Critical Illness Wellness Benefit Claim Form – Standard (formerly AllState)
• MedCom Flex Claim Form
• Avesis Vision Claim Form

• Voya Payroll Service Form
• Voya Cancellation Form
• Call 800-537-5024 for Voya Whole Life Questions
• Cancer Guardian Portability Form
• Accident Direct Bill Request
• Allstate Cancer direct bill 800-521-3535
• Allstate Online Account Setup, including Claims and policy maintenance

Equicor Life (Cigna) – Contact Putnam Human Resources, 706-485-5381

Colonial – Contact 800-325-4368

• Notice for employees on the benefits they may continue
• Employer Paid Basic Life Conversion Request– Converts to a Whole Life Policy/very expensive
• Supplemental Group Life Port Request – Port Terminates at age 70
• Retiree Life Enrollment Form – Return to Houze & Associates, Inc.
• Genomic Life Continuation Form

Port Request for Accident, Critical Illness/Cancer and Hospital Indemnity:

• Employee and Spouse Port request. Voya
  • Employee Port Rates,
  • Spouse Port Rates
  • Consumer Privacy Notice