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SGMC Forms

NameSizeDescription
Care Share Deduction Form.doc(24576)Care Share Deduction FormDownload
Bodyworks Family Fitness Application.pdf(133878)Bodyworks Family Fitness ApplicationDownload
PPP 07 – Paid Time Off Plan.pdf(534894)PPP 07 – Paid Time Off PlanDownload
Health Plan Restriction Request Form.pdf(136928)Health Plan Restriction Request FormDownload
Cancer Policy Claim Form.pdf(190811)Cancer Policy Claim FormDownload
Critical Illness Policy Claim Form.pdf(49695)Critical Illness Policy Claim FormDownload
Accident Policy Claim Form.pdf(122648)Accident Policy Claim FormDownload
Employee Medical Certification Form.pdf(209374)Employee Medical Certification FormDownload
Family Members Medical Certification.pdf(328632)Family Member Medical Certification FormDownload
FMLA Request (2016).pdf(84438)FMLA Request FormDownload
Other Type Leave Request (2016).pdf(84889)LOA Request FormDownload
Employee Medical LOA (Non-FMLA).pdf(533913)Employee Medical LOA (Non-FMLA) Request FormDownload
MILITARY SERVICEMEMBER CERTIFICATION.pdf(221484)Military Service Member Certification FormDownload
MEDICAL LOA – FAMILY MEMBER (Non-FMLA).pdf(240594)Family Member Medical LOA (Non-FMLA) Request FormDownload
Military Servicemember Serious Injury.pdf(238928)Military Service Member Serious Injury FormDownload
EDUCATION ASSISTANCE APPLICATION.pdf(21378)Education Assistance ApplicationDownload
Misc Benefits Cancellation Request Form.pdf(420796)Miscellaneous Benefits Cancellation Request FormDownload
Beneficiary Designation.pdf(167195)Beneficiary Designation FormDownload
NOP.pdf(199204)Notice of Privacy (Health Plan)Download
NOP (Spanish).pdf(283138)Notice of Privacy; Spanish (Health Plan)Download
Retirement Plan 2015 Restated.pdf(4252869)SGMC Retirement Plan (Restated 2015)Download
PTO Donation Form.pdf(108598)PTO Donation FormDownload
PTO Donation Acceptance Declination.pdf(227567)PTO Acceptance/Declination FormDownload
AccessMemberResources_071117_AVESIS.pdf(493003)Avesis Member ResourcesDownload
Avesis Participating Chain Providers.pdf(971676)Vision Participating Chain ProvidersDownload
Lens Option Overview – Members.pdf(87502)Vision Lens Option OverviewDownload
Member Technology Flyer.pdf(609393)Avesis Member Technology FlyerDownload
401k Plan Document.pdf(4510367)Money Purchase Retirement PlanDownload
YMCA Application.pdf(236677)YMCA ApplicationDownload
Wild Adventures FAQ.pdf(65387)Fall Frenzy Frequently Asked QuestionsDownload
2018 Health Plan Document.pdf(2076295)2019 Health Plan DocumentDownload
2018 Summary of Benefits and Coverage.pdf(589839)2019 SBCDownload
SGMC Dental Highlights 2019.pdf(391417)2019 Dental HighlightsDownload
SGMC 2019 Benefits Guide.pdf(2606039)2019 Benefits GuideDownload

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