Hood County

Benefit Information

• 2020-2021 BENEFIT SUMMARY

• 2020-2021 Benefit Election Form
   

• Accident Plan - Personal Accident Indemnity Delivery (PAID) - Central United Life (Manhattan Life)

  • Accident Brochure​

  • Accident Premiums

  • Accident Enrollment Application

• Cancer Plan Brochure & Enrollment Application - TransAmerica Insurance Company

• Dental - Ameritas

  • Dental High Plan

  • Dental Low Plan

  • Dental Enrollment Form

• ​Disability Plan - America United Life (AUL)
  • ​Disability Plan Enrollment Application
  • Disability Plan Enrollment Evidence of Insurability (EOI)
  • ​ComPsych Information​

• Term and Supplemental Life - Dearborn National

  • Group Term Life

  • Voluntary Life​ Evidence of Insurability (EOI)

  • Voluntary Life Application

  • Voluntary Life Premiums

  • Voluntary Life Portability Application
     

• NBS Flexible Spending Account (FSA)

Claim Forms

• Accident Claims - Central United Life (Manhattan Life)

  • Accident Claim Fax Cover Sheet​

  • Accident Claim Form

• Dental Claims - Ameritas 

• • Dental Claim Form (English)​

  • Dental Claim Form (Spanish)

• Disability Claims - OneAmerica (Click on Employee Benefits Claims)

• ​Term and Supplemental Life Claims - Dearborn
   

• NBS FSA Dependent Care Claim Form

• NBS FSA Health Care Claim Form

• NBS Direct Deposit Form