The following downloads are PDF files. They are easily viewed and printed on any computer with Acrobat® Reader installed. A free version of Acrobat® Reader can be downloaded from www.adobe.com. 

Authorization Agreement for Automatic Payment 

BIS Group Benefit Application 

Brethren Medical Plan

BMP Employee Application

Employer Quote Request Form

Medicare Supplement Plan Enrollment Form

Dental

Delta Enrollment Form

Vision

EyeMed Enrollment Form

FlexCare

Account Withdrawal Request

Election Form and Salary Reduction Agreement (Employer Groups)

Election Form and Salary Reduction Agreement (Ministers Group) 

Election Instructions (Employer Groups)

Election Instructions (Ministers Group)

Long Term Disability/Life Insurance

LTD/Life Enrollment Form (Employer Group)

LTD/Life Enrollment Form (Ministers Group)

LTD Budget Worksheet (Ministers Group)

STD Budget Worksheet

Basic & Supplemental Life Designation of Beneficiary 

Supplemental Life Enrollment Form

Retiree Life Insurance Enrollment Form

Evidence of Insurability Form