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Mennonite Church USA Mennonite Church USA
  • About
    • What We Believe
      • Statements and Resolutions
      • Confession of Faith In a Mennonite Perspective
    • History
    • Find a Church
    • FAQ
      • FAQ about Mennonites
      • FAQ about MC USA
    • Executive Board Staff
    • Church Structure
      • Area Conferences
      • Racial Ethnic Council
  • Ministry
    • Church Vitality
      • Women in Leadership
      • Church Planting
      • Wellbeing in Ministry
      • Ministerial Inquiry Form
      • Kineo Center
    • Faith Formation
      • Children and Families
      • Faith Formation with Youth
      • Faith Formation with Adults
      • Christian Practices
      • Pastors & Leaders | Deep Faith 2022
    • Peacebuilding
      • Learn Pray Join
      • Israel/Palestine Initiatives
      • Undoing Racism
      • Undoing Sexism
      • Peace and Justice Support Network
    • The Corinthian Plan
      • Corinthian Plan Staff
      • History of the Corinthian Plan
      • Why Mutual Aid Matters
      • Corinthian Plan Subsidies
      • Wellness Incentives
  • Agencies
    • Everence
    • Mennonite Education Agency
    • Mennonite Mission Network
    • MennoMedia
    • MHS
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Home / Resources / Health Coverage and Forms

Health Coverage and Forms

2023 Corinthian Plan Renewal Documents here.

Health Plan Forms

 

  • Enrollment Form for Employer: Congregational Selection Form
  • Enrollment Forms for Employees
    • Employee Enrollment form for the following states: AZ, CA, CO, DE, FL, ID, IL, IN, IA, KS, MD, MI, MN, MT, NE, OH, OK, OR, PA, SD, VA, WA
    • Employee Enrollment form for all other states 2131086 Ee Enrollment Form CEP MCUSA TCP Non-Fraternal
    • NABCO North American Benefits Company — Life and disability enrollment form
    • Dental & Vision enrollment form for employee
  • Cancellation of coverage
  • Employer HRA Enrollment and EFT Authorization

HSA and HRA Information

 

  • TCP Health Coverage with HSA
  • Health Reimbursement Arrangement
  • Everence HSAs – A Summary for Employers
  • Section 125 Cafeteria Plan for Mennonite Church USA
  • HRA and HSA Comparison Chart for Congregations
  • Everence HSA Group Contributions
  • HSA Contribution Form
  • HRA Employee Direct Submission Authorization
  • 2022 HSA Employee Contribution

Coverage Information

 

  • 2023 CEP SPD MCUSA HDHP $1,400/$2,800 Agg. Ded
  • 2023 CEP SPD MCUSA HDHP $2,000/$4,000 Agg. Ded
  • 2023 CEP SPD MCUSA HDHP $3,000/$6,000 Agg. Ded
  • 2023 CEP SPD MCUSA $1,400/$2,800 Emb Ded
  • SBC CEP MCUSA 2022 $1400 Individual Coverage Embedded Deductible
  • SBC CEP MCUSA 2022 $2800 Family Coverage Embedded Deductible
  • SBC CEP MCUSA 2023 $1400 Single Coverage HDHP
  • SBC CEP MCUSA 2023 $2800 Family Coverage HDH
  • SBC CEP MCUSA 2023 $2000 Single Coverage HDH
  • SBC CEP MCUSA 2023 $4000 Family Coverage HDH
  • SBC CEP MCUSA 2023 $3000 Single Coverage HDHP
  • SBC CEP MCUSA 2023 $6000 Family Coverage HDHP
  • Complete plan description: Summary of Benefits
  • Group Term Life
  • Overview Of Group Life And Long Term Disability **
  • Group Long Term Disability Insurance
  • Explanation of Benefits
  • Finding a Provider for your Highmark PPO Program
  • Dental Plan – (Summary of Benefits)
  • Dental Plan — Comprehensive Coverage Summary Plan Description
  • Dental – Prev & Basic Coverage SPD
  • VSP Easy Option Plan Summary
  • VSP Signature Plan Summary

    Wellness Incentives & Resources

     

    • Highmark website flyer
    • 2022 Highmark Preventive Schedule
    • Baby BluePrints – Maternity Education and Support Program
    • BCBS Complementary Wellness Discount
    • Fitness Program Discounts
    • BlueCard Worldwide Brochure
    • Blues On Call Brochure
    • Highmark BSBC Need Answers
    • The Cost of Your Health Care: What You Can Do About It

    For Updated Wellness Documents below see Wellness Incentive Webpage

    • Wellness Incentive Instructions
    • Wellbeing Conversation Flyer
    • Wellness Incentive Philosophy
    • Wellness Accountability and Support Options
    • My Wellbeing Plan & Incentive Authorization TCP
    • Wellness Exam Incentive Authorization
    • TCP Wellness Physical Exam Tips
    • Wellbeing Accountability and Support Options
    • Enrollment Form (Waived) Wellness Incentive Program
    • Wellness Incentive Philosophy TCP
    • Wellbeing Conversation Incentive Authorization

    Subsidy

     

    • Fair Balance (subsidy) Fund: Eligibility criteria
    • Application for Subsidy
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