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TEAM MEMBER/EMPLOYEE/ASSOCIATE INFORMATION:
- Premier and Basic Medical Plan Summaries
- Activity Request Form
- CHS Facilities – CHS-Affiliated Services for Lutheran Health Network employees.
- TicketsAtWork.com – Exclusive discounts, special offers, access to preferred seating and many other special perks for thousands of products including theme parks, shows, sporting events, concerts, dinner shows, movies and much more. Contact HR for the CHS company code to take advantage these special offers.
- Coordination of Benefits Form
- Instructions for Replacement Medical Card from MedPartners
- Dental Benefits—Dental Claim Statement
- Flexible Spending Account Claim Forms
- Prescription Reimbursement Claim Form
- Prescription Drug Coverage Updates
- Proton Pump Inhibitor Prior Authorization Criteria
PAYROLL AND TAX FORMS:
- Paperless Pay Stub (For pay stubs prior to 7/5/2013)
- Department of Treasury–Internal Revenue Service Form W-4
- State of Indiana–Employee's Withholding Exemption and County Status Certificate (WH-4)
- Ohio State Employee's Withholding Exemption Certificate