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SGMC Health Benefit Forms

Accident Policy Claim Form

Cancer Policy Claim Form

Critical Illness Policy Claim Form

Disability Claim Intake Form (Instructions)

Prescription Reimbursement Claim Form (paper) or log in to Caremark to submit electronically

Short-Term Disability Form (Instructions)

Education Assistance Application

PPP 07 – Paid Time Off Plan

YMCA Application

Bodyworks Family Fitness Application

Family Members Medical Certification

Military Service Member Certification Form

Military Service Member Serious Injury Form

Notice of Privacy (Health Plan)

Notice of Privacy; Spanish (Health Plan)

PTO Donation Form

PTO Acceptance/Declination Form

SGMC Retirement Plan (Restated 2015)

Avesis Member Resources

Vision Participating Chain Providers

Vision Lens Option Overview

Avesis Member Technology Flyer

Evidence of Insurability/Statement of Health

Health Plan Restriction Request Form

Miscellaneous Benefits Cancellation Request Form

Beneficiary Designation Form

2021 Health Plan Document

2021 Dental Highlights