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| Voluntary Dental and Vision Benefits |
This Program is offered by the State Employees' Insurance Board (SEIB) and is administered by Southland National Insurance Corporation
• Information
- Addendum to the 2007 LGHIP Administrative Procedures Guide
- General Information
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Medical Insurance Plan |
• Forms from the State Employees' Insurance Board website
• Open Enrollment
- Open enrollment starts November 1 and ends November 30 each year. The effective date of any changes made during open enrollment is January 1.
- Forms must be signed and completed in their entirety. Fax completed forms to City Hall (attn: Benefits Coordinator) at (205) 879-6913 for further delivery to the State Employees' Insurance Board (SEIB).
- For questions, call Jane Moore at
(205) 802-3807. |
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Flexible Benefit Plan |
• Forms
- Claim Reimbursement Form
- Debit Card Receipt Transmittal
- Grace Period Reimbursement
- Dependent Care Receipts
- Dependent Care Acknowledgement
- Family Status/Job Change Form
• General
- FSA Participant Update (2007)
- Enrollment Kit (2009)
- Online Enrollment Instructions
• Summary Plan Description
- Plan Amendment for HIPPA Privacy
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Long-Term Disability Insurance |
• Forms
- LINA Long-Term Disability Application
- LINA Physician's Statement
- On-line LTD Claim Inquiry Brochure
- Plan Description
Note: The insurance company must be notified with 31 days (or as sooon as practical) of the event resulting in the disability. Failure to make timely notification may result in the denial of the claim.
• Legend
- LTD - Long-Term Disability
- LINA - Life Insurance Company of
North America (part of the CIGNA
Insurance Group)
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Workers' Compensation |
• Forms
- First Report of Injury
- First Report of Injury Instructions |
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Group Term Life Insurance |
• Forms
- MetLife Death Claim
- MetLife Conversion Form
- Beneficiary Change Form
• Certificate of Insurance
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Dental Plan(1) |
• Summary Plan Description
• Enrollment Form
• Notice of Privacy Practices
(1) The stand-alone dental plan is available only to employees that have voluntarily declined coverage under the City's group medical/dental plan dministered by the State Employees' Insurance Board.
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| State of Alabama Ethics Commission |
• Statement of Economic Interest Forms and Instructions |
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Other Information |
• Driver History Form |
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• Employee Handbook |
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