Employee Benefits

Insurances

Health Insurance

• Benefit Summaries

  Keystone HMO
  Keystone Direct POS
  Personal Choice PPO

  Concordia Flex Dental

• Health Insurance Enrollment
• UCCI Dental Application
• Form for Declining Health Care Coverage
• Hourly Employee Contribution Rate Sheet
• Salary Employee Contribution Rate Sheet

Life Insurance - UnumProvident

• Benefit Summaries
• Beneficiary Form

Contact Debi Mondik at (610) 327-4200, extension 119 or debmondik610@aol.com for additional information

Voluntary Insurance

UnumProvident

• Voluntary Life Insurance
• Long Term Disability Insurance
• Short Term Disability Insurance
• Critical Illness Insurance
• Long Term Care Insurance
• Term Life and AD&D Insurance Enrollment Form
• Term Life and AD&D Insurance Information Sheet
• Evidence of Insurability Form

Contact Debi Mondik at (610) 327-4200, extension 119 or debmondik610@aol.com for additional information

Pottstown Medical Specialists, Inc. Profit Sharing 401(k) Plan

• The Hartford - Update
• The Hartford - Account Access
• The Hartford - Statement Information
• Enrollment Form - Investment Elections
• Enrollment Form - Contribution Elections
• Designation of Beneficiary Form
• The Hartford - Website Link
• Summary Plan Description

Contact Robert J. Bechtold at (877) 481-1814 or rbechtold@wlbechtold.com for additional information.

Employee Forms

• W-4
• I-9
• Employees Acknowledgment of Physician Panel
• Change of Address Form
• Emergency Contact Form
• Authorization Agreement for Direct Deposit
• Password Form
• Scheduled Hours Form
• Employee Handbook

More forms are on their way. Check back for the form you're looking for or contact Sue Clohecy in the main office.