Benefits Forms and Links

Health Insurance
Provider Directory
Health Expense Claim Form

Contact Information
www.bcbsga.com
1-800-441-2273

24/7 Nurseline
1-888-724-2583

Prescription
Prescription Formulary
Prescription Claim Form
Mail Order Prescription Form

Contact Information
Express Scripts Customer Service: 1-866-281-4654
First Time Users Program: 1-800-782-8476


Flexible Spending
Flex Claim Form
Eligible Flex Expenses
Questions Regarding FSA:
www.benefitadminsolutions.com/bcbsga
(Company Name: Athens-Clarke County)

BCBSGA: 1-866-747-0046
Dental Insurance
Dental Summary of Benefits

Contact Information
www.deltadentalins.com
Delta Dental: 800-521-2651

Vision Insurance
Vision Summary of Benefits
Vision Plan Document
Vision Providers - Athens area
Out-of-Network Vision Claim Form

Contact Information
www.bcbsga.com
BCBSGA: 1-800-441-2273

Life Insurance
Beneficiary Designation
Metlife Plan Document

Contact Information
Metlife: 1-800-638-6420

Family Medical Leave
Family Medical Leave Application
Family Medical Leave Fact Sheet

Short Term Disability
Short Term Disability Application

Long Term Disability
Long Term Disability Application
Waiver of Premium Application

LTD Questions
Unum: 1-800-858-6843

Waiver of Premium Questions
Metlife: 1-800-300-4296

Pension and Retirement
Pension Estimate Request
Notice of Retirement - Active Employees
Unused Vacation Payment/Deferral Option Form
Notice of Retirement - Vested Employees
Withdraw Notice of Retirement





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