LHN Forms
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TEAM MEMBER/EMPLOYEE/ASSOCIATE INFORMATION:
BENEFITS
- Premier Medical Plan
- Basic Medical Plan
- 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.
- 2009 Vision Benefits
INSURANCE FORMS:
- Coordination of Benefits Form
- Instructions for Replacement Medical Card from MedPartners
- Dental Benefits—Dental Claim Statement
- Flexible Spending Account Claim Form
- Full Time Student Verification Form
- Prescription Reimbursement Claim Form
- Prescription Drug Coverage Updates
- Proton Pump Inhibitor Prior Authorization Criteria
PAYROLL AND TAX FORMS:
©2010 Lutheran Health Network