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Team Georgia Connection
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Team Georgia Connection




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   AD&D Insurance
   Dental Insurance
   Disability Insurance
   Legal Insurance
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   Specified Illness Plan
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Flexible Benefit Forms


PDF Document Adobe PDF   Microsoft Word Document Microsoft Word  Medical History Statements External Web Link

Benefits Forms (General)
  Microsoft Word Document Change of Address Form
  PDF Document Qualifying Change In Status Form
  Microsoft Word Document Military Differential Pay Form
  PDF Document Benefit Continuation Form
  PDF Document Retiree Dental Enrollment Form


Dental Forms
  PDF Document Regular Option Claim Form
  PDF Document United Concordia Dependent Certification Form
  PDF Document United Concordia (Dental) Dependent Enrollment Printable Form
  PDF Document United Concordia AdvantagePlus Provider Directory
  PDF Document Nomination Postcard
  External Link United Concordia (Dental) Dependent Enrollment Online Form
  PDF Document CIGNA Prepaid Dentist Selection


Disability Forms
  PDF Document Disability Claim Packet - State of Georgia
  PDF Document Disability Evidence of Insurability Form
  External Link Medical History Statements - Web page for policyholders


Health Savings Account Forms
  PDF Document Beneficiary Form
  PDF Document Enrollment Package
  PDF Document Payroll Change Form


Legal Forms
  PDF Document Signature LegalCare Claim Form


Life/AD&D Forms and Conversion/Portability Information
  PDF Document Conversion Information and Form
  PDF Document Portability Information and Form


Life/AD&D Insurance Forms
  Microsoft Word Document Beneficiary Election Form
  PDF Document Beneficiary Statement Form
  PDF Document Notice of Accidental Dismemberment and Loss of Sight Claim Form
  PDF Document Notice of Claim for Accelerated Benefit Form
  PDF Document Notice of Death Claim Form
  PDF Document Notice of Disability Form
  PDF Document Preference Beneficiary's Statement Form
  PDF Document Evidence of Insurability Form
  PDF Document Waiver of Premium Claim Employer's Statement
  PDF Document Child Life Evidence of Insurability Form


Specified Illness Forms
  PDF Document Evidence of Insurability Form
  PDF Document Beneficiary Form
  PDF Document Claim Form


Spending Account Forms
  PDF Document Claim Form for Dependent Care Account
  PDF Document Claim Form for Health Care Account


Vision Forms
  PDF Document Vision Dependent Enrollment Form


Long Term Care
  PDF Document Election to Continue Long Term Care Insurance Coverage Form