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	2012 New Hire Benefits Enrollment	2012 Benefits Enrollment Guide
	Partner Agreement	Benefit Summary for Lewiston Campus
	Payroll Direct Deposit	Choice Time & Extended Sick Bank Accruals (Salaried)
	2013 Pay Check Dates	Choice Time & Extended Sick Bank Accruals (Hourly)
	Qualifying Event Form	FAQs of Qualifying Events
	W4- -Federal and State - 2013	CMMC Parking Map & Violation Notice
	Change of Name/Address Change	Voluntary Benefits: > Disablity Leave Management Programs > Travel Assistance & ID Theft Protection Services > Vision
		PPACA Notice, August 2012

Medical Plan		Medical Summary Plan Description
		About Creditable Prescription Drug Coverage and Medicare: Notice of Credible Coverage 2013
		Summary Benefits & Coverage $500
		Summary Benefits & Coverage $1,500
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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	FSA Expense List
	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 (Frozen 04/01/2011)	Notice of Withdrawal	Summary of Material Modifications
		Dear Fellow Letter of February 10, 2011 Announcing Change
		Frequently Asked Questions (FAQs)
		Copy of Notice US Mailed to Active Employee Participants in the Defined Benefit Plan
		Summary Plan Description, Restated April 1, 2011
		2012 Annual Funding Notice
		Summary of Material Modifications regarding lump-sum distributions (December 2012)

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 of Material Modifications
	Enrollment Form	SPD 401k 2012
	403(b) Auto Enrollment notice	SPD 403b 2012
	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) and 401(k) Loan Application with Instructions	Amendment 401k EACA SMM
	Waiver	Amendment 403b EACA Notice of Auto Enroll
		Amendment 403b EACA Notice
		Amendment 403b EACA SMM
		Free Disclosure 404(a)(5) Statement 8/2012

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

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 Four 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.
>	New Hire Information Healthy Decisions Wellness is an individual health and wellness program.
>	Frequently Asked Questions Answers to your FAQs about the Healthy Decisions Wellness Program.