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Employee Benefits Forms and Brochures

HEALTH

 DENTAL & VISION

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BENEFITS FORMS

MISC FORMS

State of  Mississippi Health Insurance Application

 

Guardian Dental/Vision Application

State of   Mississippi Life Insurance Application

Change in Status

TelaMed Form

Wellness - Preventive Coverage

 Guidelines

 

 Dental ID Card

 Evidence of Insurability (Late Enrollee)

Section 125 Election Form

American Fidelity GAP Claim Form

 Employee Reference Guide  Vision ID Card

 Portability Packet for Life Insurance

Name Change Form 

Affordable Care Act Information - Marketplace 

 Glossary of Health Insurance and Medical Terms  Dentist Nomination Form

Beneficiary Designation Online Instructions 

COBRA 

 

American Fidelity Change Forms

 

2018 Summary of Benefits and Coverage (SBC) for Base and Select Plans 

 Guardian Anytime 

Website

Life Ins Beneficiary Designation Form 

HIPAA Privacy Notice 

American Fidelity Reimbursement Form 

 Comparison between Base and Select Health Plans

Guardian Dental and Vision Benefit Summary 

 Conversion Brochure  Benefits Contact Information  American Fidelity Disability Claim Form

 Health Insurance Rates

Effective July 1, 2018

Employee Assistance Program - Support Services

 

 State Life Insurance Plan Certificate  Employee Assistance Program

LegalShield-IDShield Application

2018 Benefits Changes 

2018 FAQs

 

State Life Insurance Rates 

Notice of Enrollment Rights 

LegalShield-IDShield Information Flyer 

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DCS is committed to providing a work environment that is free of discrimination. It is the policy of DCS that all applicants and employees are entitled to equal employment opportunity regardless of race, color, religion or creed, gender (includes pregnancy or related medical conditions), national origin, age, disability, veteran status or other protected characteristics as required by local, state and federal law.

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5 E. South Street • Hernando, MS 38632
Phone: (662) 429-5271 • Fax: (662) 429-4198
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