ONLINE
BENEFITS
PROGRAM
 

 

Saturday February 04, 2012

Online forms

 

 

In addition to making official forms available in focused areas of the benefit directory, all forms offered are available here to expedite your retrieval of those forms.  Download the Acrobat Reader to your computer to view forms.   

New forms will be added and updated as appropriate.

 

NEW EMPLOYEE FORMS
                               
MEDICAL PLAN 
   
DENTAL PLAN 
 

Enrollment Form

Dental Claim Form

Employee Change Form

VISION PLAN 
  Application Form 
SHORT TERM DISABILITY
 

Enrollment Form

Disbility Claim Form

Employee Change Form
LONG TERM DISABILITY
 

Enrollment Form

Disability Claim Form

Employee Change Form
GROUP TERM LIFE 
 

Enrollment Form

Claim Form

Employee Change Form

401K PLAN
 

Beneficiary Designation

Directed Investment Selections

Election To Alter Salary Reductions

Hardship Distribution Application

Notice Of Eligibility To Participate

Participant's Salary Reduction Election

QDRO Procedures

IRS Tax Notice
TAX FORMS
Fill in online and print
 W-4 Federal Withholding
Fill in online and print
 NC-4  North Carolina Withholding 
Fill in online and print
 MI-4 Michigan Withholding
Fill in online and print
 INS Employee Eligibility Form
COMPANY FORMS
   

 


If you have any questions, please contact
  • Lindsey Janneck
    Human Resources/Payroll Administrator
    Rehab Solutions, Inc.
    Phone, 1-704-841-9574 ext.22 , 1-800-273-3418
    Fax, 1-888-271-3830
    ljanneck@rehabsolutionsinc.net

 

 

Note: The simplified benefit summaries contained herein are designed to be concise, simplified highlights of each benefit plan. As such, they are not comprehensive or authoritative. For complete details, please refer to the applicable benefit plan booklet provided by the insurer or your employer. In matters of tax or legal interpretation, seek the services of a qualified professional.

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