2022-2023 BENEFIT SUMMARY

2022-2023 Benefit Election Form
 

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

• Accident Brochure with Rates​

• Accident Enrollment Application

Cancer Plan Brochure & Enrollment Application - TransAmerica Insurance Company

Dental - Ameritas

• Dental High Plan

• Dental Low Plan

• Dental Enrollment Form

• ​Disability Plan Enrollment Packet​

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)

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 Online - OneAmerica (Click on Disability Claims)

Disability Claim Form - OneAmerica

​Term and Supplemental Life Claims - Dearborn
 

NBS FSA Dependent Care Claim Form

NBS FSA Health Care Claim Form

NBS Direct Deposit Form