CMMF Health Decisions


	Visit CAPHIS for links to quality health Web sites referred by the Medical Library Association.

Forms & Documents

The forms and documents on this page are generally Adobe® Acrobat® (.pdf) files. To view or print these forms, you need to have the Adobe Acrobat Reader installed on your computer. If a form is followed by (.doc), it is a Microsoft® Word Form, which requires Microsoft Word to be installed on your computer. Follow the directions on the form and submit to the appropriate party and address.

Benefit Plan/Program	Forms	Documents
General	New Hire Benefits Enrollment (.pdf)	2010 Benefits Enrollment Guide (.pdf)
	Partner Agreement (.pdf)	Benefit Summary for Lewiston Campus (.pdf)
	Payroll Direct Deposit (.pdf)	Choice Time & Extended Sick Bank Accruals (Hourly) (.pdf)
	Qualifying Event (.pdf)	Lewiston Parking Map & Violation Notice (.pdf)
	Tuition Reimbursement (.pdf)	Short-Term Disability, Vision & Accident Insurance Enrollment Information (.pdf)
	W-4 Tax Withholding (.pdf)
Medical Plan	Dependent Student Status (.pdf)	Medical Summary Plan Description (.pdf)
Medical Plan	UMR Full-time Student Designation (.pdf)	Medical Summary Plan Description (.pdf)
Dental Plan		Dental Summary Plan Description (.pdf)
Spending Accounts	Health Care Benny Card Receipt Claim (.pdf)	Spending Account Summary Plan Description (.pdf)
	Health Care Claim (.pdf)
	Dependent Care Claim (.pdf)
	Direct Deposit Authorization (.pdf)
Life Insurance Plan	Evidence of Insurability (.doc)	Life Insurance Summary Plan Description (.pdf)
Long-Term Disability Plan	Long-Term Disability Application (.pdf)	Long-Term Disability Summary Plan Description for Non-physicians (.pdf)
Long-Term Disability Plan	Long-Term Disability Application (.pdf)	Long-Term Disability Summary Plan Description for Physicians (.pdf)
Retirement: Defined Benefit Pension Plan	Enrollment (.pdf)	Annual Funding Notice (.pdf)
Retirement: Defined Benefit Pension Plan	Notice of Withdrawal (.pdf)	Summary of Material Modifications (.pdf)
Retirement: 403(b) Plan	Address Change (.pdf)	Online Access Instructions (.pdf)
	Beneficiary Designation (.pdf)
	Distribution Request (.pdf)
	Hardship Distribution Request (.pdf)
	Loan Application (.pdf)
Retirement: 457 Plan	Beneficiary Designation (.pdf)
	Distribution Request (.pdf)
	Distribution/Rollover Request (.pdf)
	Hardship Distribution Request (.pdf)
Retirement: 401(k) Bridgton Hospital		Summary Plan Description (.pdf)
		Summary of Material Modifications - Plan Expenses (.pdf)
		Summary of Material Modifications - PPA, HEART, WRERA (.pdf)