{"id":101,"date":"2017-02-21T23:08:10","date_gmt":"2017-02-21T23:08:10","guid":{"rendered":"http:\/\/mybenefitscc.wpengine.com\/nokiatechnologies\/benefits-selection\/forms\/"},"modified":"2024-11-05T00:46:42","modified_gmt":"2024-11-05T00:46:42","slug":"forms","status":"publish","type":"page","link":"https:\/\/mybenefits.cc\/saintmarys\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|desktop&#8221; admin_label=&#8221;section&#8221; _builder_version=&#8221;4.16&#8243; background_color=&#8221;#ededed&#8221; custom_padding_tablet=&#8221;50px|0|50px|0&#8243; custom_padding_phone=&#8221;&#8221; transparent_background=&#8221;off&#8221; padding_mobile=&#8221;off&#8221; make_fullwidth=&#8221;off&#8221; use_custom_width=&#8221;off&#8221; width_unit=&#8221;on&#8221; custom_width_px=&#8221;1080px&#8221; custom_width_percent=&#8221;80%&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row padding_mobile=&#8221;off&#8221; column_padding_mobile=&#8221;on&#8221; admin_label=&#8221;row&#8221; _builder_version=&#8221;4.16&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; make_fullwidth=&#8221;off&#8221; use_custom_width=&#8221;off&#8221; width_unit=&#8221;off&#8221; custom_width_px=&#8221;1080px&#8221; custom_width_percent=&#8221;80%&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text admin_label=&#8221;Forms&#8221; _builder_version=&#8221;4.16&#8243; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; use_border_color=&#8221;off&#8221; border_color=&#8221;#ffffff&#8221; border_style=&#8221;solid&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3>Forms<\/h3>\n<p>[\/et_pb_text][et_pb_tabs active_tab_background_color=&#8221;#355071&#8243; active_tab_text_color=&#8221;#ffffff&#8221; admin_label=&#8221;Coverage Tabs&#8221; _builder_version=&#8221;4.27.2&#8243; tab_font_size=&#8221;13px&#8221; background_size=&#8221;initial&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; hover_enabled=&#8221;0&#8243; z_index_tablet=&#8221;500&#8243; border_color_all=&#8221;#d8d8d8&#8243; use_border_color=&#8221;on&#8221; saved_tabs=&#8221;all&#8221; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;][et_pb_tab title=&#8221;Medical&#8221; _builder_version=&#8221;4.24.2&#8243; body_font=&#8221;||||&#8221; body_line_height=&#8221;2em&#8221; tab_font=&#8221;||||&#8221; tab_line_height=&#8221;2em&#8221; body_line_height_tablet=&#8221;2em&#8221; body_line_height_phone=&#8221;2em&#8221; tab_line_height_tablet=&#8221;2em&#8221; tab_line_height_phone=&#8221;2em&#8221; global_colors_info=&#8221;{}&#8221;]<a href=\"https:\/\/acribenefits.com\/data1\/dnload\/blueshield\/bsclaimform-bsl&amp;h.pdf\">Blue Shield Medical Claim Form<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/dnload\/blueshield\/bsrxclaimform.pdf\">Blue Shield Prescription Claim Form<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/dnload\/blueshield\/bsrxmailorder-expressscripts.pdf\">Blue Shield Prescription Mail Order Claim Form<\/a><\/p>\n<p><a href=\"https:\/\/acribenefits.com\/data1\/dnload\/kaiser\/claimform.pdf\">Kaiser Claim Form<\/a>[\/et_pb_tab][et_pb_tab title=&#8221;Dental&#8221; _builder_version=&#8221;4.27.2&#8243; body_font=&#8221;||||&#8221; body_line_height=&#8221;2em&#8221; tab_font=&#8221;||||&#8221; tab_line_height=&#8221;2em&#8221; hover_enabled=&#8221;0&#8243; body_line_height_tablet=&#8221;2em&#8221; body_line_height_phone=&#8221;2em&#8221; tab_line_height_tablet=&#8221;2em&#8221; tab_line_height_phone=&#8221;2em&#8221; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<p><a href=\"https:\/\/acribenefits.com\/data1\/forms\/guardian\/claim-dental-form.pdf\">Guardian Dental Claim Form<\/a><\/p>\n<p>[\/et_pb_tab][et_pb_tab title=&#8221;Vision&#8221; _builder_version=&#8221;4.24.2&#8243; body_font=&#8221;||||&#8221; body_line_height=&#8221;2em&#8221; tab_font=&#8221;||||&#8221; tab_line_height=&#8221;2em&#8221; body_line_height_tablet=&#8221;2em&#8221; body_line_height_phone=&#8221;2em&#8221; tab_line_height_tablet=&#8221;2em&#8221; tab_line_height_phone=&#8221;2em&#8221; global_colors_info=&#8221;{}&#8221;]<a href=\"https:\/\/acribenefits.com\/data1\/dnload\/vsp\/claimform.pdf\">VSP Vision Claim Form<\/a>[\/et_pb_tab][et_pb_tab title=&#8221;Life &#038; Disability&#8221; _builder_version=&#8221;4.24.2&#8243; body_font=&#8221;||||&#8221; body_line_height=&#8221;2em&#8221; tab_font=&#8221;||||&#8221; tab_line_height=&#8221;2em&#8221; body_line_height_tablet=&#8221;2em&#8221; body_line_height_phone=&#8221;2em&#8221; tab_line_height_tablet=&#8221;2em&#8221; tab_line_height_phone=&#8221;2em&#8221; global_colors_info=&#8221;{}&#8221;]<a href=\"https:\/\/acribenefits.com\/data1\/benefitsm\/stmarys20\/forms\/life_con.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Mutual of Omaha Life Portability Form<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/benefitsm\/stmarys20\/forms\/life_port.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Mutual of Omaha Life Conversion Form<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/benefitsm\/stmarys20\/forms\/flyer.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Mutual of Omaha Portability v.s. Conversion Flyer<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/benefitsm\/saintmarys\/2021\/life_vol_enroll.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Mutual of Omaha Enrollment Form<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/benefitsm\/saintmarys\/dis_claim.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Mutual of Omaha Disability Claim Form<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/benefitsm\/saintmarys\/std_claim.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Mutual of Omaha STD Claim Form<\/a><\/p>\n<p><a href=\"https:\/\/acribenefits.com\/data1\/saintmarys\/2023\/moo-eoi.pdf\" target=\"_blank\" rel=\"noopener\">Mutual of Omaha Evidence of Insurability Form<\/a><br \/>\n<a href=\"https:\/\/www3.mutualofomaha.com\/eoi\/#\/home?groupnumber=BNN5&amp;groupname=Saint%20Mary's%20College%20of%20California\" target=\"_blank\" rel=\"noopener\">Mutual of Omaha Evidence of Insurability Online Form<\/a>[\/et_pb_tab][et_pb_tab title=&#8221;FSA&#8221; _builder_version=&#8221;4.24.2&#8243; body_font=&#8221;||||&#8221; body_line_height=&#8221;2em&#8221; tab_font=&#8221;||||&#8221; tab_line_height=&#8221;2em&#8221; body_line_height_tablet=&#8221;2em&#8221; body_line_height_phone=&#8221;2em&#8221; tab_line_height_tablet=&#8221;2em&#8221; tab_line_height_phone=&#8221;2em&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><a href=\"https:\/\/acribenefits.com\/data1\/saintmarys\/2024\/navia\/navia-fsa-claim.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Navia FSA Claim Form<\/a><\/p>\n<p>[\/et_pb_tab][et_pb_tab title=&#8221;HRA&#8221; _builder_version=&#8221;4.24.2&#8243; body_font=&#8221;||||&#8221; body_line_height=&#8221;2em&#8221; tab_font=&#8221;||||&#8221; tab_line_height=&#8221;2em&#8221; body_line_height_tablet=&#8221;2em&#8221; body_line_height_phone=&#8221;2em&#8221; tab_line_height_tablet=&#8221;2em&#8221; tab_line_height_phone=&#8221;2em&#8221; global_colors_info=&#8221;{}&#8221;]<a href=\"https:\/\/acribenefits.com\/data1\/saintmarys\/2023\/marinbenefits-hra-claim-form.pdf\" target=\"_blank\" rel=\"noopener\">Marin Benefits HRA Claim Form<\/a>[\/et_pb_tab][et_pb_tab title=&#8221;Voluntary&#8221; _builder_version=&#8221;4.24.2&#8243; body_font=&#8221;||||&#8221; body_line_height=&#8221;2em&#8221; tab_font=&#8221;||||&#8221; tab_line_height=&#8221;2em&#8221; body_line_height_tablet=&#8221;2em&#8221; body_line_height_phone=&#8221;2em&#8221; tab_line_height_tablet=&#8221;2em&#8221; tab_line_height_phone=&#8221;2em&#8221; global_colors_info=&#8221;{}&#8221;]<a href=\"https:\/\/acribenefits.com\/data1\/benefitsm\/forms\/moo\/enroll.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Mutual of Omaha Enrollment Form<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/benefitsm\/forms\/moo\/accident_con.pdf\" target=\"_blank\" rel=\"noopener\">Mutual\u00a0 of Omaha Accident Continuation Form<\/a><br \/>\n<a href=\"https:\/\/acribenefits.com\/data1\/benefitsm\/forms\/moo\/illness_con.pdf\" target=\"_blank\" rel=\"noopener\">Mutual of Omaha Critical Illness Continuation Form<\/a>[\/et_pb_tab][et_pb_tab title=&#8221;Retirement&#8221; _builder_version=&#8221;4.24.2&#8243; body_font=&#8221;||||&#8221; body_line_height=&#8221;2em&#8221; tab_font=&#8221;||||&#8221; tab_line_height=&#8221;2em&#8221; body_line_height_tablet=&#8221;2em&#8221; body_line_height_phone=&#8221;2em&#8221; tab_line_height_tablet=&#8221;2em&#8221; tab_line_height_phone=&#8221;2em&#8221; global_colors_info=&#8221;{}&#8221;]<a href=\"https:\/\/acribenefits.com\/data1\/benefitsm\/saintmarys\/2019\/emapp.pdf\">Emeriti Post-tax Supplemental Salary Reduction Agreement<\/a>[\/et_pb_tab][\/et_pb_tabs][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Forms Blue Shield Medical Claim Form Blue Shield Prescription Claim Form Blue Shield Prescription Mail Order Claim Form Kaiser Claim FormGuardian Dental Claim FormVSP Vision Claim FormMutual of Omaha Life Portability Form Mutual of Omaha Life Conversion Form Mutual of Omaha Portability v.s. Conversion Flyer Mutual of Omaha Enrollment Form Mutual of Omaha Disability Claim [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":9,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-101","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/mybenefits.cc\/saintmarys\/wp-json\/wp\/v2\/pages\/101","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mybenefits.cc\/saintmarys\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mybenefits.cc\/saintmarys\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mybenefits.cc\/saintmarys\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mybenefits.cc\/saintmarys\/wp-json\/wp\/v2\/comments?post=101"}],"version-history":[{"count":0,"href":"https:\/\/mybenefits.cc\/saintmarys\/wp-json\/wp\/v2\/pages\/101\/revisions"}],"wp:attachment":[{"href":"https:\/\/mybenefits.cc\/saintmarys\/wp-json\/wp\/v2\/media?parent=101"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}