Cafeteria Plan

 

Shawn-Marie Riley, Conference Benefits Administrator                     

Phone:  (817)877-5222 or (800)460-8622

Fax:  (817)338-4541 (Please call to verify receipt of time sensitive materials.)

Click here to email.

 

OPEN ENROLLMENT FOR 2012 IS NOVEMBER 2ND TO NOVEMBER 17TH, 2011

NO LATE ENROLLMENTS ACCEPTED.

 

2012 Information 

New plan changes for 2012 indicated with an asterisk (*).  Policy(ies) you currently have will not change, nor will the monthly rate change.  

Cafeteria Plan Overview (pdf format)

2012 Cafe Plan Annual Enrollment Instructions   (pdf format)

Cafeteria Plan Enrollment Form 2012   (pdf format)   PRINT AND MAIL, FAX OR EMAIL ENROLLMENTS TO CONFERENCE OFFICE, NOT TO AFLAC.

Cancellation Aflac Policy Form   (pdf format)    Fax to Shawn-Marie Riley at Conference Office.  Fax No. 817-338-4541

Dental Plan Enrollment Form  (pdf format)  SEND ENROLLMENTS TO CONFERENCE OFFICE, NOT TO AFLAC.

Short Term Disability Application 2012    (pdf format)  SEND ENROLLMENTS TO CONFERENCE OFFICE, NOT TO AFLAC.

Aflac Voluntary Benefit Rates 2012 (pdf format) 

Short Term Disability Rates-Clerical Lay 2012 (pdf format) 

Short Term Disability Rates-Clergy/ Non-Clerical Lay 2012  (pdf format)  

 

Aflac Voluntary Benefits (Policies)

New plan changes for 2012 indicated with an asterisk (*). Policy(ies) you currently have will not change, nor will the monthly rate change.

Hospital Protection   (pdf format)     

Specified Health Event Protection   (pdf format)   

* Dental Overview   (pdf format)

* Dental Essentials Brochure  (pdf format)

* Dental Essentials Schedule of Benefits (pdf format)

* Dental Plan 1 Brochure  (pdf format)

* Dental Plan 1 Schedule of Benefits  (pdf format)

* Dental Orthodontic Rider   (pdf format)     The rider adds extra to your dental premium.

Maximum Difference - Cancer Indemnity Insurance   (pdf format)    

* Short Term Disability  (pdf format)   

Accident Indemnity Advantage    (pdf format)     

 

Policy Forms

Policy Claim Forms - Click on Texas on the map (from Aflac's website)

Cancellation Aflac Policy Form  - Fax to Shawn-Marie Riley at Conference Office.  Fax No. 817-338-4541

 

Aflac FlexOne Un-reimbursed Medical (URM) & Dependent Daycare (DDC) Flexible Spending Accounts

Flexible Spending Account Participants Handbook (pdf format)  

AFLAC/FLEXONE Flexible Spending Account Reimbursement Form (from Aflac's website) 

Redi-Flex Direct Deposit Enrollment Form (from Aflac's website)