Dear Flexible Spending Account (FSA) Enrollee:

Size: px
Start display at page:

Download "Dear Flexible Spending Account (FSA) Enrollee:"

Transcription

1 Dear Flexible Spending Accunt (FSA) Enrllee: Welcme t yur FSA Plan! Yu nw have 24x7 access t all yur FSA needs n the web. T access yur accunt simply lgn t Yur user name is yur first initial, last name (in all caps) and last fur digits f yur scial security number (i.e. Jhn De wuld be JDOE3333). Yur initial passwrd is: changeme. Once n the website, yu will be prmpted t change yur passwrd and asked fr a security challenge and respnse. Frm this pint, it s easy t click yur way thrugh the web-site. The web-site gives yu the ability t file claims n-line and print ff a cmpleted reimbursement frm fr submissin. Yu will als have all the necessary prgram frms available n-line fr yur use. The site als prvides yu with detailed up t-the-minute accunt infrmatin. As part f yur FSA prgram, yu will receive a MBI Debit Card. We encurage yu t take advantage f this exciting apprach in managing yur FSA. The FSA Debit Card is a special MasterCard that draws n the value f yur annual Health Care FSA and/r Dependent Care electin amunt. Each time yu incur a qualified expense nt cvered by yur regular health insurance at a business that accepts MasterCard, yu can use the Flex Debit Card. Yur qualified expenses will be deducted frm yur FSA autmatically; yur nly respnsibility will be t keep yur receipts in case they are required per IRS guidelines (see belw). The Flex Debit Card frees yu frm spending mney ut-f-pcket at the time f purchase and waiting fr reimbursement checks fr the vast majrity f expenses. The MBI MasterCard Card prvides THE MOST CONVENIENT WAY t access yur FSA cntributins. HERE S A LOOK AT REIMBURSEMENT Let s assume yu... Paying fr services ut f pcket yu wuld... With MBI yu will... Cntribute $1,000 in ne year t yur Health Care FSA Accunt (r $19.23 a week) Purchase a prescriptin (r several prescriptins) at the pharmacy, r pay a cpay at the dctr s ffice. 1. Pay what yu we. 2. Save the receipt. 3. Get a claim frm. 4. Cmplete the claim frm 5. Make a cpy f yur receipt and claim frm fr yur recrds. 6. Submit the frm and receipt fr reimbursement via fax r US mail t BenefitElect and yu will receive reimbursement 7. Wait fr reimbursement via mail/direct depsit. 1. Swipe yur MBI MasterCard 2. Save the receipts! Yu will be ntified if receipts are required (see belw). If s, use the ntificatin sent t yu as a cver sheet when returning required receipts. Receipts can als be sent in anytime alng with a Debit Card Receipt Transmittal Frm attached belw. Funds are autmatically deducted frm yur accunt! The Inventry Infrmatin Apprval System (IIAS) is nw available thrugh the MasterCard netwrk. The IIAS was designed t identify eligible healthcare purchases by cmparing the UPC r SKU number fr the items being purchased against a pre-established list f eligible medical expenses at the pint f purchase thereby eliminating the need t submit receipts at participating retail prviders (see attached listing). Receipts fr nn- IIAS prviders will still be required except fr payment f slid dllar insurance c-payments and deductibles as well as same dllar amunt expenses (i.e. prescriptin renewals). Ntificatins will be sent t yu if a receipt is required. Items will be deemed Pst Tax until the receipts are received. Thse participants, wh d nt respnd t a receipt substantiatin ntificatin within 90 days frm request, culd be subject t card suspensin. All respnses t ntificatins must be received within 6 business days after the plan year-end r the crrespnding debit card transactins may be reclassified pst tax fr IRS reprting purpses. All nn-eligible debit card claims will als be classified as pst tax fr IRS reprting purpses.

2 CLAIM FILING INSTRUCTIONS FOR HEALTH CARE EXPENSES 1. The ttal annual electin fr eligible medical expenses (less any previus reimbursements paid) may nt exceed the maximum allwed under the plan. Please review yur Summary Plan Dcument r see yur Plan Administratr fr mre infrmatin. 2. Refer t the prvisins in yur Summary Plan Dcument fr the minimum and maximum annual electin amunts. 3. Valid reimbursement claims must include a fully itemized bill including the date f service, name f claimant, type f service, etc. frm a dctr, dentist, pharmacy r ther supplier, r an explanatin f benefit statement indicating the deductible, c-insurance and amunts nt cvered by any medical/dental plan(s) (net f any amunts that have been r are t be paid by insurance r ther surces). 4. Internal Revenue Service Publicatin 502 lists the eligible tax-free expenses. An eligible expense means any item fr which yu culd have claimed a medical expense deductin n an itemized federal incme tax return fr which yu have nt therwise been reimbursed frm insurance, r sme ther surce. The expenses must be incurred by yu r yur dependents while participating in the plan and nt when they are billed t yu. CLAIM FILING INSTRUCTIONS FOR DEPENDENT CARE EXPENSES 1. The maximum amunt yu can be reimbursed during the time yu are cvered in the plan year cannt exceed the salary reductin amunts yu have elected and made under the dependent care spending accunt less any previus reimbursements paid. 2. Reimbursement payments can be made fr services prvided in r utside yur hme fr dependent child r adult dependent care in rder fr yu and yur spuse t wrk r g t schl full time. 3. Yur Maximum cntributin amunt cannt be mre than the lesser f: Yur incme r yur spuse's incme, whichever is less. If yur spuse is a full-time student r incapable f selfcare, yur spuse is cnsidered t earn $2400 per year with 1 dependent r $4800 a year with 2 r mre dependents. $5,000 per year if yur tax filing status is "married filing jintly" r "single head f husehld" r $2,500 per year if yur tax filing status is "married filing separately". 4. All expenses fr dependent care must be fr "Care". Expenses fr Kindergarten, 1st grade, and abve are nt eligible fr reimbursement accrding t the Internal Revenue Service. Cverage nly applies t: Dependents under the age f thirteen Dependent adults r children thirteen years ld r lder wh are mentally r physically incapable f self-care. 5. An itemized bill, receipt r cntract must be submitted fr reimbursement, which includes: The dependent s name The perid during which the services were rendered The name, address and taxpayer ID number f the individual r rganizatin prviding services A descriptin f the service prvided Alternatively, fr dependent care, if the abve infrmatin is dcumented n the reimbursement frm, yu may have the prvider sign the reimbursement frm in lieu f a receipt. NOTE: Cancelled checks, credit card receipts, invices r balance due statements are nt valid prf f service fr Dependent Care Expenses. Mre infrmatin n allwable claims can be fund n ur abve referenced website.

3 IMPORTANT Flexible Spending Accunt Infrmatin Yu already knw that a Flexible Spending Accunt is a smart way fr yu t put mney aside Tax Free t cver ut-f-pcket medical, dental, childcare and even dependent care csts. It s a great feeling t knw that participating in a Flexible Spending Accunt increases yur take-hme pay! Besides the savings mentined abve, Many Over-The-Cunter Drugs are eligible expenses! All yu have t d is t fllw sme simple rules (see belw). Over the Cunter Drugs The IRS has issued a new ruling fr Over the Cunter (OTC) drugs and medicatins. The IRS is nw cnsidering OTC drugs and medicatins t be reimbursable expenses. The ruling states that: 1. Reimbursements by an emplyer f amunts paid by an emplyee fr medicines and drugs purchased by the emplyee withut a physician's prescriptin are excludable frm grss incme (meaning it s an eligible FSA expense!)." In rder t be reimbursed, these items must meet the definitin f "Medical Care". "Medical Care" is defined as amunts paid fr the diagnsis, mitigatin, treatment r preventin f a disease, illness, r medical cnditin. 2. Hwever, amunts paid by an emplyee fr dietary supplements (e.g., vitamins) that are merely beneficial t the general health f the emplyee r the emplyee's spuse r dependents, are nt reimbursable r excludable frm grss incme under Cde 105(b). Yu must include cpies f yur OTC drug receipts with yur claim/transmittal frm in rder t receive reimbursement. Receipts submitted fr reimbursement f OTC drugs must indicate the actual names f the OTC drugs. This receipt displays a line item descriptin indicating which OTC drugs were purchased. THANK YOU FOR VISITING THE CONVIENANT STORE 123 LOCAL STREET ANYWHERE, USA DR: FC: 2.49 TAX:.59 TOTAL: 9.03 CASH: CHANGE:.97 SR /23/04 09:15:05 REGISTER: 6 This receipts displays unidentifiable line items that d nt indicate OTC items purchased. Items frm this receipt wuld nt be reimbursable. If yu have questins, please cntact BenefitElect at (800) (tll free) Submit yur claim frm and all supprting dcumentatin via mail r a dedicated claims fax line, which insures cnfidentiality, t ur Claims Prcessing Center at: FAX #: Claims Prcessing Center P.O. Bx Birmingham, AL 35259

4

5

6

7 FOR FASTER PROCESSING, FAX this Frm and Receipts t: r Mail Frm and Receipts t: Chappelle Benefits P.O. Bx Birmingham, AL (PLEASE KEEP YOUR ORIGINALS) Questins? us at: r call us at CLAIM REIMBURSEMENT FORM (Nt fr FSA Debit Card Receipts) FSA CLAIM REIMBURSEMENT REQUEST FORM - Receipts received with this frm will be prcessed fr reimbursement. D nt use this frm fr submitting FSA Debit Card Purchase Receipts - use the frms in yur enrllment/cnfirmatin kit r dwnlad thse frm the web. Emplyee Name Emplyee ID / SSN: Daytime Phne Number Address Emplyer Name Health Care Reimbursement Claim (HCRA-nn-reimbursed medical) - Yu MUST attach a bill, receipt r Explanatin f Benefits (EOB) verifying the date f service r prduct, type f service r prduct, name f persn receiving service and amunt claimed. Date f Service Type Fr Whm (name and relatinship) Amunt 1. $ 2. $ If yu have mre items t list, please use page 2 f this claim frm. Dependent Care Reimbursement Claim (DCRA) - Yu MUST attach a bill r receipt frm yur dependent care prvider verifying the dependent s name, name, address and taxpayer ID number (SSN r TIN) f prvider, perid which services were rendered, descriptin f services and amunt. If the Dependent Care Prvider signs the apprpriate area belw, receipts are nt required. Dependent s Name, Relatinship Date f Service and Date f Birth Prvider s Name and Address Prvider s Tax ID/SSN Amunt 1. $ 2. $ PROVIDER CERTIFICATION: I hereby certify that the abve Dependent Care charges have been incurred. Dependent Care Prvider Signature If yu have mre items t list, please use page 2 f this claim frm. Date Healthcare Reimbursement Arrangement (HRA) - Yu MUST attach a bill, receipt r Explanatin f Benefits (EOB) verifying the date f service r prduct, type f service r prduct, name f persn receiving service and amunt claimed. Date f Service Type Fr Whm (name and relatinship) Amunt 1. $ 2. $ Outside Premium Reimbursement Accunt (OPRA) - Attach a bill r receipt indicating the nn-cmpany premium healthcare payment Date f Service Type Fr Whm (name and relatinship) Amunt 1. $ 2. $ I hereby certify that all items I requested t be reimbursed cmply with the Flexible Spending Accunt Plan and such items have nt and will nt be cvered by any ther plan r prgram f any emplyer r ther persn nr have these items been paid fr by a debit card r stred value card ffered with the Flexible Spending Accunt Plan. I further certify that such items will nt be deducted r taken as tax credits n my persnal federal and state incme tax returns fr any year. The cmpany des nt accept respnsibility fr direct payment t any individuals ther than the emplyee. Participant Signature X Date

8 ** IF YOU DON T HAVE ONLINE ACCESS TO YOUR ACCOUNT, PLEASE PROVIDE YOUR ABOVE AND CHECK THIS BOX [ ] - WE WILL INSTRUCTIONS. ** FOR FASTER PROCESSING, FAX this Frm and Questins? Receipts t: us at: r Mail Frm and Receipts t: Chappelle Benefits r call us at P.O. Bx Birmingham, AL (PLEASE KEEP YOUR ORIGINALS) CLAIM REIMBURSEMENT FORM Page 2 (Nt fr FSA Debit Card Receipts) FSA CLAIM REIMBURSEMENT REQUEST FORM - Receipts received with this frm will be prcessed fr reimbursement. D nt use this frm fr submitting FSA Debit Card Purchase Receipts - use the frms in yur enrllment/cnfirmatin kit r dwnlad thse frm the web. Emplyee Name Emplyee ID / SSN: Daytime Phne Number Address Emplyer Name Health Care Reimbursement Claim (HCRA-nn-reimbursed medical) - Yu MUST attach a bill, receipt r Explanatin f Benefits (EOB) verifying the date f service r prduct, type f service r prduct, name f persn receiving service and amunt claimed. Date f Service Type Fr Whm (name and relatinship) Amunt 3. $ 4. $ 5. $ 6. $ 7. $ 8. $ 9. $ 10. $ Dependent Care Reimbursement Claim (DCRA) - Yu MUST attach a bill r receipt frm yur dependent care prvider verifying the dependent s name, name, address and taxpayer ID number (SSN r TIN) f prvider, perid which services were rendered, descriptin f services and amunt. If the Dependent Care Prvider signs the apprpriate area belw, receipts are nt required. Dependent s Name, Relatinship Date f Service and Date f Birth Prvider s Name and Address Prvider s Tax ID/SSN Amunt 3. $ 4. $ PROVIDER CERTIFICATION: I hereby certify that the abve Dependent Care charges have been incurred. Dependent Care Prvider Signature Date I hereby certify that all items I requested t be reimbursed cmply with the Flexible Spending Accunt Plan and such items have nt and will nt be cvered by any ther plan r prgram f any emplyer r ther persn nr have these items been paid fr by a debit card r stred value card ffered with the Flexible Spending Accunt Plan. I further certify that such items will nt be deducted r taken as tax credits n my persnal federal and state incme tax returns fr any year. The cmpany des nt accept respnsibility fr direct payment t any individuals ther than the emplyee. Participant Signature X Date

9 FOR FASTER PROCESSING, FAX this Frm and Receipts t: r Mail Frm and Receipts t: Chappelle Benefits P.O. Bx Birmingham, AL (PLEASE KEEP YOUR ORIGINALS) Questins? us at: r call us at mbi MasterCard DEBIT CARD RECEIPT TRANSMITTAL COVER SHEET Yur cmpliance is required t meet IRS required FSA Debit Card receipt review Use this cver sheet if yu are faxing r mailing mbi MasterCard Receipts. This is nt a claim reimbursement frm. Reimbursements will nt be prcessed if this frm is used. Emplyee Name Emplyee ID / SSN - - Daytime Phne Number Address Emplyer Name MBI MasterCard Number Attach cpies f yur receipts with this cver sheet. Acclaris will receive yur FAX and secure the cntent accrding t HIPAA Privacy requirements. Be sure that yu r thers n yur behalf secure yur data at the pint f riginatin. Original receipts will nt be returned. Nte: The custmer is respnsible fr misrepresentatin regarding requests fr reimbursement. If yu have any further questins please cntact custmer service. Date and incurred csts Transactin Date Merchant Name Fr Whm (name and relatinship) Amunt 1. $ 2. $ 3. $ 4. $ 5. $ 6. $ Use additinal sheet(s) if necessary TOTAL AMOUNT OF ATTACHED RECEIPTS $ I certify that I am authrized t use the MasterCard issued and that by signing and using the debit card, I agree t all terms and cnditins. I understand that any transactins initiated by my use f an authrized Card are subject t the terms and cnditins f the Cardhlder Agreement received with the Card. I certify that the qualified healthcare expenditures presented with this transmittal have been received by an eligible individual and are true and accurate. I further certify that these expenses have nt, nr will be, reimbursed thrugh insurance r any ther arrangement. Participant Signature X Date

High Deductible Health Plan/ Health Savings Account Presentation

High Deductible Health Plan/ Health Savings Account Presentation High Deductible Health Plan/ Health Savings Accunt Presentatin WHY CHANGE? Future plan structured s emplyees will think and act differently Prmte preventin and getting healthier Prmtes cnsumerism Current

More information

Account Switch Kit. Locations. HACKLEBURG PO DRAWER A 34888 US HWY 43 HACKLEBURG, AL 35564 Phone: (205)395-1944 Fax: (205)935-3349

Account Switch Kit. Locations. HACKLEBURG PO DRAWER A 34888 US HWY 43 HACKLEBURG, AL 35564 Phone: (205)395-1944 Fax: (205)935-3349 Member FDIC "Hmetwn Banking... Accunt Switch Kit... Mving Made Easy" Lcatins HAMILTON PO BO 189 1281 MILITARY ST S HAMILTON, AL 35570 Phne: (205)921-9400 Fax: (205)921-9708 HACKLEBURG PO DRAWER A 34888

More information

Enrollment Information

Enrollment Information Enrllment Infrmatin IU HEALTH LA PORTE HOSPITAL FLEXIBLE SPENDING ACCOUNT DEBIT CARD GUIDE Effective: January 1, 2013 HEALTHSMART BENEFIT SOLUTIONS, INC. Table f Cntents Intrducing Yur FSA Debit Card......

More information

RIVERSIDE TRANSIT AGENCY FULL-TIME ATU EMPLOYEES NEW HIRE ENROLLMENT OVERVIEW 2015

RIVERSIDE TRANSIT AGENCY FULL-TIME ATU EMPLOYEES NEW HIRE ENROLLMENT OVERVIEW 2015 RIVERSIDE TRANSIT AGENCY FULL-TIME ATU EMPLOYEES NEW HIRE ENROLLMENT OVERVIEW 2015 Riverside Transit Agency (RTA) is extremely prud f the package f benefits available t yu. The benefits package prvided

More information

The Family Cost Share system is designed so families with the ability to pay will share in the cost of services.

The Family Cost Share system is designed so families with the ability to pay will share in the cost of services. Paying fr Early Childhd Interventin Services What is ECI? Texas Early Childhd Interventin (ECI) prgrams serve families with children birth t 36 mnths with develpmental delays r disabilities. ECI prvides

More information

2015-16 Independent Verification Worksheet for HSC Students

2015-16 Independent Verification Worksheet for HSC Students 15IVHP 2015-16 Independent Verificatin Wrksheet fr HSC Students Yur applicatin was selected fr review in a prcess called verificatin. In this prcess, Temple University will be cmparing infrmatin frm yur

More information

insurers cannot deny coverage for patients with preexisting conditions or because an insured got sick;

insurers cannot deny coverage for patients with preexisting conditions or because an insured got sick; The Affrdable Care Act Health Insurance Respnsibilities f Large, Midsize & Small Emplyers; Buying Insurance n the Individual Health Insurance Marketplace and the Small Business Health Optins Prgram Intrductin:

More information

Merchant Processes and Procedures

Merchant Processes and Procedures Merchant Prcesses and Prcedures Table f Cntents EXHIBIT C 1. MERCHANT INTRODUCTION TO T-CHEK 3 1.1 Wh is T-Chek Systems? 3 1.2 Hw t Cntact T-Chek Systems 3 1.3 Hw t Recgnize T-Chek Frms f Payment 3 1.3.1

More information

Health Care Reform Patient Protection Affordable Care Act (PPACA) Overview Key Principles

Health Care Reform Patient Protection Affordable Care Act (PPACA) Overview Key Principles Health Care Refrm Patient Prtectin Affrdable Care Act (PPACA) Overview Key Principles DESCRIPTION: Healthcare Refrm/Patient Prtectin & Affrdable Care Act (PPACA) were passed int law March 23. 2010. Hwever,

More information

PATIENT LIABILITY STATEMENT

PATIENT LIABILITY STATEMENT PATIENT LIABILITY STATEMENT We will nt initiate therapeutic services until signed authrizatin is prvided. I understand that I am persnally respnsible fr charges incurred fr services rendered by the ffice

More information

Health Savings Accounts (HSAs) Distribution Rules

Health Savings Accounts (HSAs) Distribution Rules Brught t yu by Haylr, Freyer & Cn, Inc. Health Savings Accunts (HSAs) Distributin Rules A Health Savings Accunt (HSA) is a trust r accunt used t pay medical expenses that a high deductible health plan

More information

FTE is defined as an employee who is employed on average at least 30 hours of service per week.

FTE is defined as an employee who is employed on average at least 30 hours of service per week. On March 23, 2010, President Barack Obama signed int law cmprehensive health care refrm legislatin, the Patient Prtectin and Affrdable Care Act (H.R. 3590) passed in the Senate. The Health Care and Educatin

More information

Coordinating Dual Eligibles Medicare and Medicaid Managed Medical Assistance Benefits

Coordinating Dual Eligibles Medicare and Medicaid Managed Medical Assistance Benefits Crdinating Dual Eligibles Medicare and Medicaid Managed Medical Assistance Benefits Medicare beneficiaries wh have limited incme and resurces may get help paying fr their Medicare premiums and ut-f-pcket

More information

Agency Fund (Non-Student Org X-Fund) Guidelines Last Revision: 12/7/2009

Agency Fund (Non-Student Org X-Fund) Guidelines Last Revision: 12/7/2009 Agency Fund (Nn-Student Org X-Fund) Guidelines Last Revisin: 12/7/2009 Definitin f Agency Fund: An Agency Fund cnsists f funds held by Eastern Michigan University as custdian r fiscal agent fr thers, such

More information

CLEARANCE REVIEWS FOR STUDENT RESTRICTION ISSUES OTHER THAN ACADEMIC PROGRESS

CLEARANCE REVIEWS FOR STUDENT RESTRICTION ISSUES OTHER THAN ACADEMIC PROGRESS CLEARANCE REVIEWS FOR STUDENT RESTRICTION ISSUES OTHER THAN ACADEMIC PROGRESS Only the Ministry f Training, Clleges & Universities can cnsider clearance reviews fr mst ther student restrictin issues. These

More information

WHAT SHOULD I LOOK FOR WHEN I BUY HEALTH INSURANCE?

WHAT SHOULD I LOOK FOR WHEN I BUY HEALTH INSURANCE? WHAT SHOULD I LOOK FOR WHEN I BUY HEALTH INSURANCE? The Maine Bureau f Insurance 34 State Huse Statin Augusta, Maine 04333 207-624-8475 r 1-800-300-5000 (in Maine) http://www.maine.gv/pfr/insurance Paul

More information

Office Use Only Account # Approved By:

Office Use Only Account # Approved By: Office Use Only Accunt # Apprved By: Dealer Applicatin Please cmplete and submit this applicatin alng with a cpy f yur (EIN) Federal Tax Id Number certificate befre placing yur 1 st rder. We will review

More information

VET FEE-HELP Frequently Asked Questions for Students May 2010

VET FEE-HELP Frequently Asked Questions for Students May 2010 Hw d I apply? VET FEE-HELP Frequently Asked Questins fr Students May 2010 If yu are eligible fr VET FEE-HELP assistance and wuld like t btain a VET FEE-HELP lan, yu shuld btain a Request fr VET FEE-HELP

More information

Employer Dashboard Guide

Employer Dashboard Guide Emplyer Dashbard Guide A step-by-step guide t the functinalities and capabilities f the Emplyer Dashbard We make it easy fr yu t manage yur plan using the Emplyer Dashbard. Each user assigned with an Administratr

More information

Enrollee Health Assessment Program Implementation Guide and Best Practices

Enrollee Health Assessment Program Implementation Guide and Best Practices Enrllee Health Assessment Prgram Implementatin Guide and Best Practices March 2015 033129 (03-2015) This guide will help yu answer these questins: What is the Enrllee Health Assessment (EHA) prgram and

More information

FIREFIGHTER HEART AND CIRCULATORY MALFUNCTION BENEFITS PROGRAM STANDARD OPERATING GUIDELINES Approved by the DOLA Executive Director July 1, 2014

FIREFIGHTER HEART AND CIRCULATORY MALFUNCTION BENEFITS PROGRAM STANDARD OPERATING GUIDELINES Approved by the DOLA Executive Director July 1, 2014 FIREFIGHTER HEART AND CIRCULATORY MALFUNCTION BENEFITS PROGRAM STANDARD OPERATING GUIDELINES Apprved by the DOLA Executive Directr July 1, 2014 Prgram Overview: As f July 1, 2014, the Department f Lcal

More information

Open Enrollment September 1, 2012

Open Enrollment September 1, 2012 Open Enrllment September 1, 2012 Open Enrllment Agenda What s SWOOSH? What is Open Enrllment? What Frms D I Need t Cmplete? New Medical Plans and Rates UHC Resurces FSA Infrmatin Cverage fr Overage Dependents:

More information

NEWFIELD CENTRAL SCHOOL HEALTH INSURANCE

NEWFIELD CENTRAL SCHOOL HEALTH INSURANCE Health/Rx & Dental/Visin Benefits Enrllment/Change rm Please Print Please Cmplete ALL Applicable Sectins Emplyee Infrmatin: Emplyee Benefit Office Use Only H/Rx: WC E Dental: WC A Visin: WC D am Indv am

More information

INCOME TAX INSURANCE PERSONAL SICKNESS AND ACCIDENT INSURANCE TAKEN OUT BY EMPLOYEE WITH EMPLOYER PAYING THE PREMIUMS ON EMPLOYEE S BEHALF

INCOME TAX INSURANCE PERSONAL SICKNESS AND ACCIDENT INSURANCE TAKEN OUT BY EMPLOYEE WITH EMPLOYER PAYING THE PREMIUMS ON EMPLOYEE S BEHALF QUESTION WE VE BEEN ASKED QB 15/09 INCOME TAX INSURANCE PERSONAL SICKNESS AND ACCIDENT INSURANCE TAKEN OUT BY EMPLOYEE WITH EMPLOYER PAYING THE PREMIUMS ON EMPLOYEE S BEHALF All legislative references

More information

BridgeValley Community and Technical College Financial Aid Office 2015-2016 Maximum Hour Financial Aid Suspension Appeal Process

BridgeValley Community and Technical College Financial Aid Office 2015-2016 Maximum Hour Financial Aid Suspension Appeal Process BridgeValley Cmmunity and Technical Cllege Financial Aid Office 2015-2016 Maximum Hur Financial Aid Suspensin Appeal Prcess T receive financial aid administered by BridgeValley Cmmunity and Technical Cllege,

More information

Dear Georgia Tech Retiree,

Dear Georgia Tech Retiree, Dear Gergia Tech Retiree, Open Enrllment is the ne pprtunity yu have each year t make changes t yur existing benefit cverage. The 2015 benefits Open Enrllment perid will be held Nvember 3, 2014 thrugh

More information

The Jackson Laboratory Third-Party Fundraising Guidelines

The Jackson Laboratory Third-Party Fundraising Guidelines The Jacksn Labratry Third-Party Fundraising Guidelines DEFINITION A Third-Party Fundraiser ( Fundraiser ) is defined as an rganizatin, crpratin, grup r individual raising mney fr The Jacksn Labratry (the

More information

LOUISIANA TECH UNIVERSITY Division of Student Financial Aid Post Office Box 7925 Ruston, LA 71272

LOUISIANA TECH UNIVERSITY Division of Student Financial Aid Post Office Box 7925 Ruston, LA 71272 LOUISIANA TECH UNIVERSITY Divisin f Student Financial Aid Pst Office Bx 7925 Rustn, LA 71272 Dear Financial Aid Applicant, Accrding t yur 2011-2012 Student Aid Reprt (SAR), yu did nt include any parental

More information

How to put together a Workforce Development Fund (WDF) claim 2015/16

How to put together a Workforce Development Fund (WDF) claim 2015/16 Index Page 2 Hw t put tgether a Wrkfrce Develpment Fund (WDF) claim 2015/16 Intrductin What eligibility criteria d my establishment/s need t meet? Natinal Minimum Data Set fr Scial Care (NMDS-SC) and WDF

More information

IMPORTANT INFORMATION ABOUT MEDICAL CARE FOR YOUR WORK-RELATED INJURY OR ILLNESS

IMPORTANT INFORMATION ABOUT MEDICAL CARE FOR YOUR WORK-RELATED INJURY OR ILLNESS IMPORTANT INFORMATION ABOUT MEDICAL CARE FOR YOUR WORK-RELATED INJURY OR ILLNESS MEDICAL PROVIDER NETWORK (MPN) NOTIFICATION If yu are injured at wrk, Califrnia Law requires yur emplyer t prvide and pay

More information

Special Tax Notice Regarding 403(b) (TSA) Distributions

Special Tax Notice Regarding 403(b) (TSA) Distributions Special Tax Ntice Regarding 403(b) (TSA) Distributins P.O. Bx 7893 Madisn, WI 53707-7893 1-800-279-4030 Fax: (608) 237-2529 The IRS requires us t prvide yu with a cpy f the Explanatin f Direct Rllver,

More information

Loan Application for Pre- Approval

Loan Application for Pre- Approval Lan Applicatin fr Pre- Apprval Get pre-apprved fr yur hme lan financing tday by cmpleting this applicatin. Please cmplete the entire applicatin and return with the dcumentatin requested n the attached

More information

WHAT YOU NEED TO KNOW ABOUT. Protecting your Privacy

WHAT YOU NEED TO KNOW ABOUT. Protecting your Privacy WHAT YOU NEED TO KNOW ABOUT Prtecting yur Privacy YOUR PRIVACY IS OUR PRIORITY Credit unins have a histry f respecting the privacy f ur members and custmers. Yur Bard f Directrs has adpted the Credit Unin

More information

Wire Transfer Request

Wire Transfer Request Wire Transfer Request Requirements and Instructins OFFICE OF DISBURSEMENTS Categry: Dcument Name: Payment Prcessing Wire Transfer Request - Requirements and Instructins Respnsible Department: Office f

More information

CSAT Account Management

CSAT Account Management CSAT Accunt Management User Guide March 2011 Versin 2.1 U.S. Department f Hmeland Security 1 CSAT Accunt Management User Guide Table f Cntents 1. Overview... 1 1.1 CSAT User Rles... 1 1.2 When t Update

More information

Workers Compensation Employee Packet

Workers Compensation Employee Packet Wrkers Cmpensatin Emplyee Packet Cmplete the fllwing frms and return t Meagan Vrhies, Claims Crdinatr via fax (817) 735-0127, email at Meagan.Vrhies@untsystem.edu r in persn at Human Resurce Services (EAD-280).

More information

Skrill Merchant Services Application Form

Skrill Merchant Services Application Form Skrill Merchant Services Applicatin Frm Skrill Merchant Services Applicatin Frm (the Applicatin ) shuld be signed by r n behalf f the Merchant. It is very imprtant that the Merchant has read the Applicatin

More information

2016-17 Independent Verification Worksheet for HSC Students

2016-17 Independent Verification Worksheet for HSC Students 16IVHP 2016-17 Independent Verificatin Wrksheet fr HSC Students Yur applicatin was selected fr review in a prcess called verificatin. In this prcess, Temple University will be cmparing infrmatin frm yur

More information

NYU Langone Medical Center NYU Hospitals Center NYU School of Medicine

NYU Langone Medical Center NYU Hospitals Center NYU School of Medicine Title: Identity Theft Prgram Effective Date: July 2009 NYU Langne Medical Center NYU Hspitals Center NYU Schl f Medicine POLICY It is the plicy f the NYU Langne Medical Center t educate and train staff

More information

Point2 Property Manager Quick Setup Guide

Point2 Property Manager Quick Setup Guide Click the Setup Tab Mst f what yu need t get started using Pint 2 Prperty Manager has already been taken care f fr yu. T begin setting up yur data in Pint2 Prperty Manager, make sure yu have cmpleted the

More information

Cell Phone & Data Access Policy Frequently Asked Questions

Cell Phone & Data Access Policy Frequently Asked Questions Cell Phne & Data Access Plicy Frequently Asked Questins 1. Wh is eligible fr a technlgy allwance? First and fremst, the technlgy allwance is fr the benefit f the University, rather than fr the cnvenience

More information

Understanding a new kind of financial assistance. Jessica Dunbar, Individual Market Manager

Understanding a new kind of financial assistance. Jessica Dunbar, Individual Market Manager Understanding a new kind f financial assistance Jessica Dunbar, Individual Market Manager Financial Assistance thrugh Cnnect fr Health Clrad-Agenda Overview f regulatins and streamlining eligibility fr

More information

THE CITY UNIVERSITY OF NEW YORK IDENTITY THEFT PREVENTION PROGRAM

THE CITY UNIVERSITY OF NEW YORK IDENTITY THEFT PREVENTION PROGRAM THE CITY UNIVERSITY OF NEW YORK IDENTITY THEFT PREVENTION PROGRAM 1. Prgram Adptin The City University f New Yrk (the "University") develped this Identity Theft Preventin Prgram (the "Prgram") pursuant

More information

SMSF Annual Accounts and Statutory Returns

SMSF Annual Accounts and Statutory Returns SMSF Annual Accunts and Statutry Returns Thank yu fr cnsidering SMSF Wrks t undertake the preparatin f yur fund s statutry accunts. We have attempted t utline the dcumentatin required t cmplete yur fund

More information

FINANCIAL OPTIONS. 2. For non-insured patients, payment is due on the day of service.

FINANCIAL OPTIONS. 2. For non-insured patients, payment is due on the day of service. FINANCIAL OPTIONS 1. Fr thse patients wh carry dental insurance, all c-payments are due n date f service. We will file yur claim as a service t yu, and will d ur very best t maximize yur benefits. We accept

More information

BRILL s Editorial Manager (EM) Manual for Authors Table of Contents

BRILL s Editorial Manager (EM) Manual for Authors Table of Contents BRILL s Editrial Manager (EM) Manual fr Authrs Table f Cntents Intrductin... 2 1. Getting Started: Creating an Accunt... 2 2. Lgging int EM... 3 3. Changing Yur Access Cdes and Cntact Infrmatin... 3 3.1

More information

Are Insurance Premiums Deductible?

Are Insurance Premiums Deductible? Are Insurance Premiums Deductible? December 2011 Can I deduct the premiums? That s a questin yu prbably hear when yu re presenting an insurance cncept. Unfrtunately, the answer is generally n insurance

More information

University of Texas at Tyler 2015-2016 Special Circumstances Request Independent Student

University of Texas at Tyler 2015-2016 Special Circumstances Request Independent Student University f Texas at Tyler 2015-2016 Special Circumstances Request Independent Student Student Name: ID#: Sectin I. In accrdance with Federal regulatins, student and spuse 2014 incme is used t determine

More information

o I hereby request a total SURRENDER of my contract/certificate (please enclose).

o I hereby request a total SURRENDER of my contract/certificate (please enclose). Distributin Request Frm Prtective Life Insurance Cmpany (PLICO/"the Cmpany") Prtective Life and Annuity Insurance Cmpany (PLAIC/"the Cmpany") Cntract Owner Custmer Service Office: Cntract Annuitant P.O.

More information

Provision Senate HELP Committee Bill (Affordable Health Choices Act) House Tri-Committee Bill, H.R. 3200 Individual Mandate

Provision Senate HELP Committee Bill (Affordable Health Choices Act) House Tri-Committee Bill, H.R. 3200 Individual Mandate August 7, 2009 Cmparisn f the Cverage Prvisins in the Affrdable Health Chices Act as Apprved by the Senate HELP Cmmittee and the Huse Tri-Cmmittee Bill, H.R. 3200, America s Affrdable Health Chices Act

More information

Payment Options Check Payable to Account Holder* Electronic Funds Transfer (ACH) $5.00 Maintain IRA with The Bancorp (contact us for options)

Payment Options Check Payable to Account Holder* Electronic Funds Transfer (ACH) $5.00 Maintain IRA with The Bancorp (contact us for options) Dear Custmer: Thank yu fr cntacting Custmer Care regarding the clsure f yur Individual Retirement Accunt (IRA). In rder t prcess yur request, please cmplete the enclsed Request fr Distributin frm. Yu may

More information

January 2015 *Benefits Highlights for Medical Center Employees

January 2015 *Benefits Highlights for Medical Center Employees January 2015 *Benefits Highlights fr Medical Center Emplyees Health Insurance Plans A Tricare Supplement plan is ffered t Tricare eligible emplyees: all ther emplyees have t the ptin t enrll in the MUSC

More information

ES PROCEDURES FOR OVERPAYMENT RECOVERY

ES PROCEDURES FOR OVERPAYMENT RECOVERY ES PROCEDURES FOR OVERPAYMENT RECOVERY Effective: 7/1/2012 Respnsible Office: Emplyee Services (ES) Apprved: ES Directr Applicatin: All Emplyees f the University f Clrad Plicy The University f Clrad will

More information

CORPORATE CREDIT CARD POLICY

CORPORATE CREDIT CARD POLICY TITLE: POLICY OWNERS: DATE INSTITUTED: May 1, 2008 CURRENT VERSION: Ver. 1.6 REVISION DATE: July 1, 2015 Crprate Credit Card Plicy Melissa Cluse, Vice President & Cntrller Cindy Klein, Accunts Payable

More information

We will record and prepare documents based off the information presented

We will record and prepare documents based off the information presented Dear Client: We appreciate the pprtunity f wrking with yu regarding yur Payrll needs. T ensure a cmplete understanding between us, we are setting frth the pertinent infrmatin abut the services that we

More information

iphone Mobile Application Guide Version 2.2.2

iphone Mobile Application Guide Version 2.2.2 iphne Mbile Applicatin Guide Versin 2.2.2 March 26, 2014 Fr the latest update, please visit ur website: www.frte.net/mbile Frte Payment Systems, Inc. 500 West Bethany, Suite 200 Allen, Texas 75013 (800)

More information

Application Fee Schedule Please check the appropriate box below. See also Additional Information starting on page 6.

Application Fee Schedule Please check the appropriate box below. See also Additional Information starting on page 6. DRIVING SCHOOL LICENSE APPLICATION N. APPLICATION DMV USE ONLY N. LICENSE Received Fee Amunt Expiratin Fee Amunt PART 1 Schl Infrmatin: l READ VEHICLE AND TRAFFIC LAW SECTION 394 AND DMV COMMISSIONER S

More information

Solo 401(k)s Self-Directed Retirement Accounts for Sole Proprietors & Small Business Owners

Solo 401(k)s Self-Directed Retirement Accounts for Sole Proprietors & Small Business Owners Sl 401(k)s Self-Directed Retirement Accunts fr Sle Prprietrs & Small Business Owners 2008 Security Trust Cmpany Security Trust Cmpany Security Trust Cmpany is a retirement plan administratr nly and des

More information

VCB ib@nking USER GUIDE FOR INDIVIUAL. VCB ib@nking USER GUIDE FOR INDIVIUAL (FOR INDIVIUAL)

VCB ib@nking USER GUIDE FOR INDIVIUAL. VCB ib@nking USER GUIDE FOR INDIVIUAL (FOR INDIVIUAL) VCB ib@nking USER GUIDE FOR INDIVIUAL (FOR INDIVIUAL) 1 Cntent Hw t access VCB-iB@nking: www.vietcmbank.cm.vn... 3 Lgin VCB-iB@nking... 4 Hme/ Navigatin:... 5 Inquiry accunt... 6 Payment... 12 Card management...

More information

Service Request Form

Service Request Form New Prfessinal Services Order Frm Editable PDF Service Request Frm If yu have any questins while filling ut this frm, please cntact yur CDM, email Prfessinal Services at PS@swipeclck.cm, r call 888-223-3250

More information

Skrill Merchant Services Application Form

Skrill Merchant Services Application Form Skrill Merchant Services Applicatin Frm Skrill Merchant Services Applicatin Frm (the Applicatin ) shuld be signed by r n behalf f the Merchant. It is very imprtant that the Merchant has read the Applicatin

More information

Merchant Management System. New User Guide CARDSAVE

Merchant Management System. New User Guide CARDSAVE Merchant Management System New User Guide CARDSAVE Table f Cntents Lgging-In... 2 Saving the MMS website link... 2 Lgging-in and changing yur passwrd... 3 Prcessing Transactins... 4 Security Settings...

More information

Medi-Pak Advantage MA-PD Option 1 (PFFS) is a Medicare Advantage organization with a Medicare contract.

Medi-Pak Advantage MA-PD Option 1 (PFFS) is a Medicare Advantage organization with a Medicare contract. January 1 December 31, 2011 Evidence f Cverage: Yur Medicare Health Benefits and Services and Prescriptin Drug Cverage as a Member f Medi-Pak Advantage MA-PD Optin 1 (PFFS) This bklet gives yu the details

More information

Application for Cathedral Kitchen s Culinary Arts Training Program

Application for Cathedral Kitchen s Culinary Arts Training Program Applicatin fr Cathedral Kitchen s Culinary Arts Training Prgram Cathedral Kitchen s Culinary Arts Training (CAT) prgram is an Equal Opprtunity Educatinal prgram. Enrllment is ffered n the basis f qualificatins,

More information

Loan Repayment Planning Worksheet

Loan Repayment Planning Worksheet Lan Repayment Planning Wrksheet Date: Think f yur federal student lans as yur EDUCATION MORTGAGE. It is the financing yu ve brrwed t make this imprtant investment in yurself. The gd news is that this mrtgage

More information

University of Texas at Dallas Policy for Accepting Credit Card and Electronic Payments

University of Texas at Dallas Policy for Accepting Credit Card and Electronic Payments University f Texas at Dallas Plicy fr Accepting Credit Card and Electrnic Payments Cntents: Purpse Applicability Plicy Statement Respnsibilities f a Merchant Department Prcess t Becme a Merchant Department

More information

Bill Payment Agreement & Disclosures

Bill Payment Agreement & Disclosures Bill Payment Agreement & Disclsures Welcme t Online Banking Bill Payment Service. Use f the Bill Payment Service indicates acceptance f terms and cnditins set frth in the Online Banking Agreement & Disclsures

More information

Table of Contents. Welcome to Employee Self Service... 3 Who Do I Call For Help?... 3

Table of Contents. Welcome to Employee Self Service... 3 Who Do I Call For Help?... 3 ALABAMA STATE UNIVERSITY HUMAN RESOURCES EMPLOYEE SELF SERVICE USER GUIDE 2 Table f Cntents Welcme t Emplyee Self Service... 3 Wh D I Call Fr Help?... 3 Hw d I access Emplyee Self Service?... 4 Persnal

More information

Customer Reference Guide. How to manage your account

Customer Reference Guide. How to manage your account Custmer Reference Guide Hw t manage yur accunt Online Renewal Prcess Lg n t www.yubradband.in Yu can click either n QUICK PAY r thrugh MY ACCOUNT drp dwn bx QUICK PAY helps yu renew yur accunt ONLINE just

More information

Student Web Time Entry Guide

Student Web Time Entry Guide Student Web Time Entry Guide Updated July 6, 2015 TABLE OF CONTENTS TABLE OF CONTENTS... 1 GETTING STARTED... 2 HOW TO ACCESS BANNER ONLINE... 2 HOW TO ENTER CURRENT TIMESHEETS... 2 HOW TO ENTER PREVIOUS

More information

Your application binds neither yourself nor ING Belgium until the loan agreement has been signed in your ING branch, and after verification by ING.

Your application binds neither yourself nor ING Belgium until the loan agreement has been signed in your ING branch, and after verification by ING. Frequently Asked Questins My applicatin fr an ING lan has been accepted. S, where d I have t g t sign the agreements? What is the minimum term fr an instalment lan? What is the maximum term fr an instalment

More information

Improved ADP and ACP Safe Harbor Plan Designs

Improved ADP and ACP Safe Harbor Plan Designs Imprtant Infrmatin Plan Administratin and Operatin April 2000* Imprved ADP and ACP Safe Harbr Plan Designs WHO'S AFFECTED This infrmatin applies t defined cntributin plans with a 401(k) feature r emplyer

More information

401(k) Savings Plan Annual Incentive Compensation Election Special Considerations for Deferred Compensation Plan Participants

401(k) Savings Plan Annual Incentive Compensation Election Special Considerations for Deferred Compensation Plan Participants Nvember 2014 401(k) Savings Plan Annual Incentive Cmpensatin Electin Special Cnsideratins fr Deferred Cmpensatin Plan Participants This dcument is a supplement t the U.S. Retirement Savings Prgram materials

More information

Transportation Allowance Program

Transportation Allowance Program Transprtatin Allwance Prgram Respnsibilities, Prcedures and Guidelines I. INTRODUCTION This manual describes respnsibilities, prcedures and guidelines (including vehicle specificatins and reimbursable

More information

Using PayPal Website Payments Pro UK with ProductCart

Using PayPal Website Payments Pro UK with ProductCart Using PayPal Website Payments Pr UK with PrductCart Overview... 2 Abut PayPal Website Payments Pr & Express Checkut... 2 What is Website Payments Pr?... 2 Website Payments Pr and Website Payments Standard...

More information

Application for 477 Services

Application for 477 Services An Indian Rerganizatin Act Village Under Act f Cngress June 15 th, 1935 32 Chilkat Ave. Klukwan, Alaska 99827 HC60 Bx 2207 Haines, Alaska 99827 Phne: 907-767-5505 Fax: 907-767-5408 klukwan@chilkat-nsn.gv

More information

YOU MUST INCLUDE ALL THE FOLLOWING ITEMS IN ORDER TO PROCESS PAYMENT FOR YOUR SERVICES

YOU MUST INCLUDE ALL THE FOLLOWING ITEMS IN ORDER TO PROCESS PAYMENT FOR YOUR SERVICES Please fill ut cmpletely and send back t 216.475.1579 r vendrpackets@garick.cm YOU MUST INCLUDE ALL THE FOLLOWING ITEMS IN ORDER TO PROCESS PAYMENT FOR YOUR SERVICES We must receive: 4 pages f Vendr packet

More information

Durango Merchant Services QuickBooks SyncPay

Durango Merchant Services QuickBooks SyncPay Durang Merchant Services QuickBks SyncPay Gateway Plug-In Dcumentatin April 2011 Durang-Direct.cm 866-415-2636-1 - QuickBks Gateway Plug-In Dcumentatin... - 3 - Installatin... - 3 - Initial Setup... -

More information

Frequently Asked Questions about the Faith A. Fields Nursing Scholarship Loan

Frequently Asked Questions about the Faith A. Fields Nursing Scholarship Loan ARKANSAS STATE BOARD OF NURSING 1123 S. University Avenue, Suite 800, University Twer Building, Little Rck, AR 72204 Phne: (501) 686-2700 Fax: (501) 686-2714 www.arsbn.rg Frequently Asked Questins abut

More information

PROPOSAL SUMMARY. The Boeing Company

PROPOSAL SUMMARY. The Boeing Company PROPOSAL SUMMARY The Being Cmpany Emplyees Represented by Sciety f Prfessinal Engineering Emplyees in Aerspace (SPEEA), Prfessinal and Technical Units January 8, 2016 ACTIVE MEDICAL, DENTAL, AND INSURANCE

More information

Electronic Data Interchange (EDI) Requirements

Electronic Data Interchange (EDI) Requirements Electrnic Data Interchange (EDI) Requirements 1.0 Overview 1.1 EDI Definitin 1.2 General Infrmatin 1.3 Third Party Prviders 1.4 EDI Purchase Order (850) 1.5 EDI PO Change Request (860) 1.6 Advance Shipment

More information

efusion Table of Contents

efusion Table of Contents efusin Cst Centers, Partner Funding, VAT/GST and ERP Link Table f Cntents Cst Centers... 2 Admin Setup... 2 Cst Center Step in Create Prgram... 2 Allcatin Types... 3 Assciate Payments with Cst Centers...

More information

Norwood Public Schools Internet & Cell Phone Use Agreement School Year 2015-16

Norwood Public Schools Internet & Cell Phone Use Agreement School Year 2015-16 Yu must read and agree t fllw the netwrk rules belw t use yur netwrk accunt r access the internet. Nrwd Public Schls makes available t students access t cmputers and the Internet. Students are expected

More information

Health Care Reform: The New Law

Health Care Reform: The New Law Health Care Refrm: The New Law Prfessr Sidney D. Watsn April 7, 2010 On March 23, 2010 President Obama signed int law the Patient Prtectin and Affrdable Care Act (H.R. 3590). On March 29, the President

More information

Workers' Compensation Employee's Guide

Workers' Compensation Employee's Guide Wrkers' Cmpensatin Emplyee's Guide Intrductin What is Wrkers' Cmpensatin? What is a Wrk-Related Injury? Wh Is Cvered by the UCSD Wrkers' Cmpensatin Prgram and When? Where D Yu Receive Initial Medical Treatment?

More information

Note: Additional Information Regarding Reporting Requirements Is Presented Following This Table. Allowable. Instructions Name

Note: Additional Information Regarding Reporting Requirements Is Presented Following This Table. Allowable. Instructions Name Nte: Additinal Infrmatin Regarding Reprting Requirements Is Presented Fllwing This Table. Clumn Clumn Allwable Instructins Name Values A SSN Numbers 9-digit SSN, including lead zeres if applicable D nt

More information

Page 1 of 7. o o o o. Sincerely, Danielle Oar, MT-BC Owner and Music Therapist

Page 1 of 7. o o o o. Sincerely, Danielle Oar, MT-BC Owner and Music Therapist Page 1 f 7 Thank yu fr chsing Refuge Music Therapy fr yur care! We are cmmitted t making yur experience healing and empwering. We strive fr the highest level f care, cmmunicatin, and therapeutic envirnment.

More information

Application Submission Checklist To Mutual of Omaha For Medicare Supplement Coverage NEW YORK

Application Submission Checklist To Mutual of Omaha For Medicare Supplement Coverage NEW YORK Mutual f Omaha Insurance Cmpany P.O. Bx 3608 Omaha, Nebraska 68103-3608 Applicatin Submissin Checklist T Mutual f Omaha Fr Medicare Supplement Cverage NEW YORK THIS APPLICATION MUST BE USED TO WRITE MUTUAL

More information

Credit Work Group Recommendation

Credit Work Group Recommendation Credit Wrk Grup Recmmendatin T: Credit Wrk Grup Frm: Mike Bixby (305) 829-5549 mbixby@inf1team.cm Paul Wills (770) 740-7353 Paul.Wills@equifax.cm Date: Octber 7, 2004 Re: FACT Act Implicatins and Recmmendatins

More information

Internet and E-Mail Policy User s Guide

Internet and E-Mail Policy User s Guide Internet and E-Mail Plicy User s Guide Versin 2.2 supprting partnership in mental health Internet and E-Mail Plicy User s Guide Ver. 2.2-1/5 Intrductin Health and Scial Care requires a great deal f cmmunicatin

More information

FundingEdge. Guide to Business Cash Advance & Bank Statement Loan Programs

FundingEdge. Guide to Business Cash Advance & Bank Statement Loan Programs Guide t Business Cash Advance & Bank Statement Lan Prgrams Cash Advances: $2,500 - $1,000,000 Business Bank Statement Lans: $5,000 - $500,000 Canada Cash Advances: $5,000 - $500,000 (must have 9 mnths

More information

LASA. Swansea s Credit Union. Loan Application Form. Loans and Savings Abertawe

LASA. Swansea s Credit Union. Loan Application Form. Loans and Savings Abertawe LASA Lans and Savings Abertawe Swansea s Credit Unin Lan Applicatin Frm Frequently Asked Questins YOUR QUESTIONS ANSWERED PLEASE READ CAREFULLY Hw much can I brrw? The amunt f any lan granted is subject

More information

Gaston Family Health Services, Inc.

Gaston Family Health Services, Inc. Gastn Family Health Services, Inc. 1.2 POLICY Gastn Family Health Services is dedicated t prviding quality health care including health educatin and preventative care services t all members f the cmmunity

More information

CLIENT PORTAL GUIDE SUMMARY

CLIENT PORTAL GUIDE SUMMARY CLIENT PORTAL GUIDE SUMMARY Using the CISI nline prtal is simple. Just g t www.culturalinsurance.cm and fllw the steps belw. As the grup administratr, simply g t the green mycisi buttn n the tp f the page

More information

Accounting Guidelines for Not-For- Profit Organizations

Accounting Guidelines for Not-For- Profit Organizations Accunting Guidelines fr Nt-Fr- Prfit Organizatins Table f Cntents Intrductin... 2 Banking Infrmatin... 2 Cash Receipts... 2 Depsit Bk... 2 Cheque Disbursements Jurnal... 3 Cheque bk... 3 Petty Cash...

More information

Sprint Flex Plans Eligibility and Enrollment Section Effective January 1, 2015

Sprint Flex Plans Eligibility and Enrollment Section Effective January 1, 2015 Sprint Flex Plans Eligibility and Enrllment Sectin Effective January 1, 2015 What is Inside Sprint Flex Plans... 3 Wh Is Eligible T Participate In Sprint Flex Plans... 3 Duplicate Cverage... 7 Enrllment...

More information

Employer Phone Number City State ZIP Patient Relationship to Responsible Party. Name of Insured Date of Birth

Employer Phone Number City State ZIP Patient Relationship to Responsible Party. Name of Insured Date of Birth PATIENT INFORMATION Patient Registratin Frm (Please Print) Title (Mrs./Miss/Ms/Dr) Hw did yu hear abut us? Referral? Patient s Name (Last) (First) (Middle) Als Knwn As Name (Last) (First) Marital Status

More information

New Student-Athlete Medical Clearance Instructions

New Student-Athlete Medical Clearance Instructions New Student-Athlete Medical Clearance Instructins 2014-15 Academic Year T: New Brevard Cllege Student-Athletes & Parents/Guardians, Prir t participating n a Brevard Cllege Intercllegiate Athletic Team,

More information