Choctaw Professional Resources Enterprise

NEW EMPLOYEE DOCUMENTS
CPRE Job Application CPRE Employee Manual CPRE Manual receipt and acknowledgment form Confidentiality Agreement CPRE CME Expense Report Emergency Information Form CPRE VET-100 Survey W4 Form State Tax Forms Employment Eligibility Verification (I-9) SCA employees - Memorandum For QNEC Form 673 - Foreign Earned Income Exemption Employee Direct Deposit Form Legal Domicile International Employees only Acknowledgement of PTE Health Welfare Paid into QNEC- Part-Time Acknowledgement of PTE Health Welfare Paid into QNEC-HR Acknowledgement of Notice of Waiting Period for SCA - HR Acknowledgement of Notice of Waiting Period for SCA- Full-Time Name/Address Change Taxation of Americans Abroad

TIMESHEETS CPRE Time Sheet Timesheet Instructions Leave Request Form

EXPENSE REPORTS CPRE LVT Form CPRE TDY Travel Expense Report

LABOR LAWS EEOC Americans with Disabilities Act (ADA) ADA Public Law 101-336 Family & Medical Act (FMLA)-Domestic Employees only FMLA Public Law 103-3-Domestic Employees only FMLA Employee Form - Certification of Health Care Provider-Domestic Employees only Employee rights under the National Labor Relations Act

2010 Federal Holidays

NEW AETNA DOMESTIC INSURANCE FORMS
2010 Domestic Benefits enrollment Form
2010 Domestic Open Enrollment Letter
2010 Domestic Rate Sheet
2010 Contract Open Access Managed Choice
How to Find a Provider in Your Area
Vision One
Integrated Health and Disability Auth
Dental Benefit Summary
Employee Retirement Income Security Act (ERISA)
Using Your Aetna Vision Benefits
Children’s Health Insurance Program (CHIP)

CLAIM FORMS
Medical Claim Form
Dental Claim Form
Rx Claim Form
Vision Claim Form

SHORT-TERM DISABILITY (STD)
Short-Term Disability Forms
Choctaw Behavioral Health Clinician Statement
Choctaw Attending Physician Statement
Choctaw Disability Employee Request for Information
Choctaw HIPAA Auth Form

INSURANCE BOOKLETS
Benefit Plan Comprehensive Medical Booklet
Benefit Plan Open Access Managed Choice Booklet
Benefit Plan Open Choice Medical Booklet
Electronic Letter
Group Policy
Member Letter
SOB Open Access Managed Choice- Contract Employees
SOB Open Choice Medical Plan
SOB Traditional Choice- Contract Employees
Standalone PPO Dental Book
Standalone PPO Dental SOB
Complaint and Appeals Health Rider
Arizona Complaint and Appeals Health Rider
Louisiana Complaint and Appeals Health Rider
Mississippi Complaint and Appeals Health Rider
Oklahoma Complaint and Appeals Health Rider
Texas Complaint and Appeals Health Rider
Life Insurance - Summary of Coverage (Non-Corporate)
Life Insurance - Proof of Death
Long Term Disability - Summary of Coverage (Non-Corporate)
Temporary Disability Income - Summary of Coverage
Temporary Disability Income - Booklet
All You Need to Know about H1N1 Flu

NEW AETNA INTERNATIONAL INSURANCE FORMS
2010 International Enrollment Form
2010 International Employee Rate Sheet
2010 International Open Enrollment Letter
Aetna Global Benefits
Dental Indemnity Plan
International Employee Assistance Program (IEAP)
How Aetna Pays OON Claims *Simplified*
International Temp Card
Pharmacy
PPO Bermuda plan design
Medical, Dental, Vision and Rx Claim Form
Proof of Death
How to Submit a Life Claim
PPO & Prescription Drug Forms
Life and Accidental Death Forms
Comprehensive Dental Forms
Long-Term Disability Forms
Vision Forms
Make strides toward a healthier lifestyle
Fast Facts - Pre-trip Planning Resources
Take a virtual tour of your AGB Benefits!
AGB Fast Facts - Aetna Navigator

LONG-TERM DISABILITY (LTD)
Long-Term Disability Forms

NEW CLAIM ADDRESS FOR AGB:
Aetna Global Benefits/Aetna
P.O. Box 981543
El Paso, TX 79998-1543
USA

NOTE: All original enrollment paperwork must be mailed to:
Robin French
CMSE Insurance Manager
2101 W. Arkansas
Durant, OK 74701

WORKERS COMPENSATION
Domestic Claim Form

International Claim Form

FMLA Employee Form - Certification of Health Care Provider-Domestic Employees only

NOTE: All Workers Comp paperwork must be faxed to:
           (580) 924-5764
           Attn: Trina Dunegan
           Workers Comp Manager
           2101 W. Arkansas St.
           Durant, OK 74701

401(K)
General Information
Enrollment Form*
Beneficiary Form*
Custodian Form*
Investment Performance Review
Rollover Form
Catch-Up Contribution Form
Contribution Change Form
Early Withdrawal of Benefits Form
QNEC Form
Principal Plan Summary
404(c) Notice
Understanding Investing (Investor Profile Quiz Included)
Russell LifePoints
Principal LifeTime Portfolios
Principal Managed Account Program
PMAP Disclosure Document
Redemption Fee & Transfer Restriction
Fund Transfer Restrictions
Principal Blackout Notice
2005 Summary Annual Report
Retirement Plan Check-Up
EGTRRA Tax Credit Info
How to Read Your Statement
Educational Materials
Investment Performance History
Termination Memo*
Principal Termination Contact*

Provider Link

Takes you to the Principal Financial Group Website

NOTE: Fax all 401(k) paperwork to:
           Latisha Potter
           (580)924-5764
           or email to: lpotter@cmse.net

           Original paperwork must be mailed to:
           CMSE-CAE-CPRE-CCS 401K Plan
           Attn: Latisha Potter
           2101 W. Arkansas
           Durant, OK 74701

MD Dental Rider
MD OAMC Medical Rider
MI Dental Rider
MI Medical Rider
MO Comprehensive Medical Rider
MO OAMC Medical Rider
MS OAMC Medical Rider
MS PPO Dental Rider
MT Medical Rider
NC OAMC Medical Rider
NC PPO Dental Rider
NE Medical Rider
NJ Medical Rider
NJ PPO Dental Rider
NM Medical Rider
NV Dental Rider
NV Medical Rider
NY Dental Rider
NY Medical Rider
OH Dental Rider
OH OAMC Medical Rider
SC Dental Rider
SC Medical Rider
SD Comprehensive Medical Rider
TN Medical Rider
TX Comprehensive Dental Rider
TX Medical Rider
UT Medical Rider
VT Dental Rider
VT Medical Rider
WA Dental Rider
WA OAMC Medical Rider
WY Medical Rider