SGMC Forms


Name Size Description
Care Share Deduction Form.doc (24576) Care Share Deduction Form Download
Bodyworks Family Fitness Application.pdf (133878) Bodyworks Family Fitness Application Download
PPP 07 - Paid Time Off Plan.pdf (534894) PPP 07 - Paid Time Off Plan Download
Health Plan Restriction Request Form.pdf (136928) Health Plan Restriction Request Form Download
Cancer Policy Claim Form.pdf (190811) Cancer Policy Claim Form Download
Critical Illness Policy Claim Form.pdf (49695) Critical Illness Policy Claim Form Download
Accident Policy Claim Form.pdf (122648) Accident Policy Claim Form Download
Employee Medical Certification Form.pdf (209374) Employee Medical Certification Form Download
Family Members Medical Certification.pdf (328632) Family Member Medical Certification Form Download
FMLA Request (2016).pdf (84438) FMLA Request Form Download
Other Type Leave Request (2016).pdf (84889) LOA Request Form Download
Employee Medical LOA (Non-FMLA).pdf (533913) Employee Medical LOA (Non-FMLA) Request Form Download
MILITARY SERVICEMEMBER CERTIFICATION.pdf (221484) Military Service Member Certification Form Download
MEDICAL LOA - FAMILY MEMBER (Non-FMLA).pdf (240594) Family Member Medical LOA (Non-FMLA) Request Form Download
Military Servicemember Serious Injury.pdf (238928) Military Service Member Serious Injury Form Download
EDUCATION ASSISTANCE APPLICATION.pdf (21378) Education Assistance Application Download
Misc Benefits Cancellation Request Form.pdf (420796) Miscellaneous Benefits Cancellation Request Form Download
Beneficiary Designation.pdf (167195) Beneficiary Designation Form Download
NOP.pdf (199204) Notice of Privacy (Health Plan) Download
NOP (Spanish).pdf (283138) Notice of Privacy; Spanish (Health Plan) Download
Retirement Plan 2015 Restated.pdf (4252869) SGMC Retirement Plan (Restated 2015) Download
PTO Donation Form.pdf (108598) PTO Donation Form Download
PTO Donation Acceptance Declination.pdf (227567) PTO Acceptance/Declination Form Download
AccessMemberResources_071117_AVESIS.pdf (493003) Avesis Member Resources Download
Avesis Participating Chain Providers.pdf (971676) Vision Participating Chain Providers Download
Lens Option Overview - Members.pdf (87502) Vision Lens Option Overview Download
Member Technology Flyer.pdf (609393) Avesis Member Technology Flyer Download
401k Plan Document.pdf (4510367) Money Purchase Retirement Plan Download
YMCA Application.pdf (236677) YMCA Application Download
Wild Adventures FAQ.pdf (65387) Fall Frenzy Frequently Asked Questions Download
2018 Health Plan Document.pdf (2076295) 2019 Health Plan Document Download
2018 Summary of Benefits and Coverage.pdf (589839) 2019 SBC Download
SGMC Dental Highlights 2019.pdf (391417) 2019 Dental Highlights Download
SGMC 2019 Benefits Guide.pdf (2606039) 2019 Benefits Guide Download
SGMC 2019 Benefits Guide.pdf (2606039) Benefits Guide Download

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