Forms

• Notification of New Hire Form
  • Notify LCC Worker Benefit Plans to begin the enrolment process into the LCC Pension Plan and/or the Group Benefits Program
  • Use for a newly hired employee, a "transferred" member or a returning employee
  • All eligible workers must be enrolled within 31 days of their eligibility date
  • Includes general information and instructions to assist in the completion of the form
• Request for Change - Report any changes of (within 31 days)
  • Address
  • Marital status
  • Salary
  • Add or terminate dependents
  • Termination of employment
  • Transfers
  • Maternity/Paternity Leave
• Election of Benefits on Maternity/Paternity Leave - Please have the employee complete this form for Maternity/Paternity leave and submit it to Worker Benefits Plans with the Request for Change.
• Election of Pension and Benefits Participation for Employees While on Leave Without Pay (including Pastors between calls)
• Group Benefits Plans - Employer Subscription Agreement
• Dental Claim Form
• Health Care Claim Form (includes Vision)
• Pre-Authorized Payment Authorization: Worker Benefit Plans Employer Contributions
• Employer Agency Agreement

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