2381. RSA 100-C Change of Beneficiary Prior to Retirement Form - Alabama
INSTRUCTIONS: ALABAMA CHANGE OF BENEFICIARY FORM PRIOR TO RETIREMENT (Form RSA 100-C) Prior to your retirement, if you wish to change the beneficiaries who will receive the accumulated credits from your contributions to your Alabam ...
2382. Form WC 4 Claims Summary Form - Alabama
INSTRUCTIONS: ALABAMA CLAIMS SUMMARY FORM (Form WC 4) When an Alabama employee is injured on the job, their employer is required to provide workers compensation coverage for treatment. The insurance company is required to submit a ...
2383. CL-438 Medical Expense Claim - Alabama
INSTRUCTIONS: BLUECROSS BLUESHIELD OF ALABAMA MEDICAL EXPENSE CLAIM (Form CL-438) Alabama public employees enrolled in a state health care plan administered by BlueCross BlueShield of Alabama file the form discussed in t ...
2384. Southland Benefit Solutions Vision Claim Form - Alabama
INSTRUCTIONS: ALABAMA SOUTHLAND BENEFIT SOLUTIONS VISION CLAIM FORM Alabama public employees enrolled in the state's vision care administered through Southland Benefit Solutions use the form discussed in this article ...
2385. Form J400 ADA Dental Claim Form - Alabama
INSTRUCTIONS: ALABAMA ADA DENTAL CLAIM FORM Alabama public employees receiving supplemental dental coverage administered by Southland Benefit Solutions can use the claim form discussed in this article. This document can ...
2386. Southland Benefit Solutions Injury or Sickness Insurance Claim - Alabama
INSTRUCTIONS: ALABAMA SOUTHLAND BENEFIT SOLUTIONS EMPLOYEE'S STATEMENT Alabama state employees enrolled in medical coverage administered by Southland Benefit Solutions can use the form discussed in this article to fi ...
2387. Instructions for Filing Death Benefit Claims - Alabama
INSTRUCTIONS: ALABAMA DEATH BENEFIT CLAIMS EXAMPLES OF SUPPORTING DOCUMENTATION This article discusses an information document outlining acceptable supporting documentation for support claims due to the death of an Alaba ...
2388. Form B Death Benefit Claim Form - Alabama
INSTRUCTIONS: ALABAMA DEATH BENEFIT CLAIM FORM (Form B) As part of the death benefit claim process for survivors of Alabama peace officer or fireman who have had their claim denied, a form B will be filed. This document ...
2389. Form C Supplemental Claim Form - Alabama
INSTRUCTIONS: ALABAMA SUPPLEMENTAL CLAIM (Form C) The form discussed in this article is used to file a claim for expenses not paid by an Alabama public department or agency. This document can be obtained from the website ...
2390. Form A Claim Form - Alabama
INSTRUCTIONS: ALABAMA CLAIM FORM (Form A) Alabama public employees can use a form A as part of the claims process related to an on-the-job accident or injury. This documentary can be obtained from the website maintained ...