CMHC Human Resources

Forms & Documents

The forms and documents on this page are generally Adobe® Acrobat® files. To view or print these forms, you need to have the Adobe Acrobat Reader installed on your computer.

Follow the directions on the form and submit to the appropriate party and address.

Benefit Plan/Program	Forms	Documents
General	2011 New Hire Benefits Enrollment	2011 Benefits Enrollment Guide
	Partner Agreement	2011 Benefits Open Enrollment Presentation Slides
	Payroll Direct Deposit	September 2010 Benefit Changes Summary, FAQs
	2011 Pay Check Dates	2011 Benefit Summary for Lewiston Campus
	Qualifying Event Form	2011 Choice Time & Extended Sick Bank Accruals (Salaried)
	W4-Federal-2012	2011 Choice Time & Extended Sick Bank Accruals (Hourly)
	W4-Maine-2012	FAQs of Qualifying Events
		CMMC Parking Map & Violation Notice
		2011 Short-Term Disability, Vision & Accident Insurance Enrollment Information

Medical Plan		Medical Summary Plan Description
		About Creditable Prescription Drug Coverage and Medicare: > Notice of Creditable Coverage 2011 > Notice of Creditable Coverage 2012
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Dental Plan		Dental Summary Plan Description

Spending Accounts	Health Care Benny Card Receipt Claim	Spending Account Summary Plan Description
	Health Care Claim	2011 Spending Account Changes & Eligible OTC Items
	Dependent Care Claim
	Direct Deposit Authorization
	Doctor's Statement of Medical Necessity

Life Insurance Plan	Evidence of Insurability - EOI	Life Insurance Summary Plan Description
	Beneficiary Change Form

Long-Term Disability Plan	Evidence of Insurability-EOI	Long-Term Disability Summary Plan Description for Non-physicians
	Long-Term Disability Application	Long-Term Disability Summary Plan Description for Physicians

Retirement: Defined Benefit Pension Plan	Notice of Withdrawal	2010 Annual Funding Notice
		Summary of Material Modifications
		Dear Fellow Letter of February 10, 2011 Announcing Change
		Frequently Asked Questions (FAQs)
		Schedule of Employee Information Meetings in February and March 2011
		Copy of Notice US Mailed to Active Employee Participants in the Defined Benefit Plan
		Summary Plan Description, Restated April 1, 2011
		2010 Form 5500 Actuarial Information

Retirement: 403(b) & 401(k) Plan	Address Change	Online Access Instructions
	Beneficiary	FAQs for Bridgton Employees - 401(k) to 403(b)
	Deduction Change	403(b) Summary Plan Description
	3/31/11 DB Refund	403(b) Summary of Material Modifications
	Enrollment Form	401(k) Summary Plan Description
	403(b) Auto Enrollment notice	401(k) Summary of Material Modifications
	401(k) Auto Enrollment notice	403(b) Summary Annual Report for 12/31/10
	Hardship Distribution Request	Amendment 401k EACA Notice of Auto Enroll
	Withdrawal Request	Amendment 401k EACA Notice
	403(b) Loan Application	Amendment 401k EACA SMM
	Waiver	Amendment 403b EACA Notice of Auto Enroll
		Amendment 403b EACA Notice
		Amendment 403b EACA SMM

Retirement: 457 Plan	Beneficiary Designation
	Distribution Request
	Distribution/Rollover Request
	Hardship Distribution Request

Retirement: 401(k) Bridgton Hospital		Summary Plan Description
		Summary of Material Modifications - Plan Expenses
		Summary of Material Modifications - PPA, HEART, WRERA
		Bridgton Hospital 401(k) SAR
		FAQs for Bridgton Employees - 401(k) to 403(b)

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

>	Benefits Overview Introducing a robust set of tools and resources to help you make Healthy Decisions about your benefits.
>	Medical Plan Quality health care, extensive resources and valuable tools.
>	Dental Plan Diagnostic, preventive and restorative services, and orthodontia.
>	Spending Accounts Set aside money from your paycheck to pay for health expenses.
>	Life Insurance Generous basic, supplemental and dependent life insurance programs.
>	Long-Term Disability Insurance Benefits to help cope with loss of your regular income in case of sickness or accident.
>	Retirement Savings Plan Three different options to help prepare for retirement.
>	Choice Time & Extended Sick Bank Paid time-off for full-time and regular part-time employees.
>	Employee Assistance Program (EAP) Free and confidential professional assistance.

>	Wellness Program Overview Dedicated to creating a culture of health and well-being that empowers employees to choose well and live well.
>	Key Features Programs, services, and resources that facilitate lifelong positive behavior changes.
>	Healthy Decisions Advantage Program Provides reimbursement up to $125 per calendar year.
>	Health Counseling Sessions For employees with chronic disease risk factors.
>	Eating Smart Explore how focusing on smart everyday choices can help you reach your health goals.
>	Exercise Discover ways to push yourself towards a healthier lifestyle.
>	Smoking Cessation Our free Quit for Good program is available to anyone, anytime, anyplace.
>	Plus-Care Management Free service for participants who would like assistance in coordinating their care and other personal needs.
>	Frequently Asked Questions Answers to your FAQs about the Healthy Decisions Wellness Program.