Choctaw Professional Resources Enterprise

NEW EMPLOYEE DOCUMENTS
CPRE Job Application Confidentiality Agreement 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 Name/Address Change Taxation of Americans Abroad Choctaw Archiving ESS10 DA Release Form w FCRA FY2011 Memorandum For QNEC FY2011 Acknowledgement Health Welfare Paid into QNEC - part time employee-HR FY2011 Acknowledgement of Health Welfare are Paid into QNEC - part time employee FY2011 Acknowledgement of Notice of Waiting Period for SCA - Full-time employees FY2011 Acknowledgement of Notice of Waiting Period for SCA - HR FY2011 Acknowledgement of PTE Health Welfare are Paid into QNEC.pdf Effective October 1, 2011 FY2012 Memorandum for QNEC FY2012 Acknowledgement of PTE Health Welfare Paid into QNEC-HR Copy FY2012 Acknowledgement of PTE Health Welfare are Paid into QNEC - EMPLOYEE COPY FY2012 Acknowledgement of Notice of Waiting Period for SCA - HR Copy FY2012 Acknowledgement of Notice of Waiting Period for SCA - FTE Copy CPRE Manual receipt and acknowledgment form CPRE Employee Manual

TIMESHEETS CPRE Time Sheet Timesheet Instructions Leave Request Form

EXPENSE REPORTS CPRE LVT Form CPRE TDY Travel Expense Report CPRE CME Expense Report Request for CME Usage

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

2011 Federal Holidays

NEW AETNA DOMESTIC INSURANCE FORMS
2012 Domestic RATE SHEET
Medical Enrollment Form
Dental Enrollment Form
Choctaw Enterprises 2012 OK OAMC Non-Corporate Plan Design
Non-Corporate Life and Disability Summary

Children’s Health Insurance Program (CHIP)
Notice of Dependent Coverage
Grandfathered health plan
HIPAA Rights
Lifetime Limit No Longer Applies
Notice of Patient Protection
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
Health Care Reform Notices - 2010
Group Policy Amendment
Group Policy Rider
Appeals Procedure Amendment
Appeals Procedure Rider
Important Health Care Reform Notices

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
Booklet Rider
Electronic Letter
Group Policy
Member Letter
Customer Notice
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
Open Access Managed Choice- Contract Employees Rider
Policy Rider
Complaint and Appeals Health Rider
Extraterritorial 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
Treatment of Mental Disorders and Substance Abuse
Mental Disorders and Substance Abuse Policy 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
INTERNATIONAL open enrollment dates:
December 10 2010 through January 10, 2011
Information Letter
2012 International RATE SHEET
Enrollment Form
CAE, CPRE, CCS_Plan B_2012 Summary Grid
CAE, CPRE, CCS_Plan D_2012 Summary Grid
CAE, CPRE, CCS_Plan E_2012 Summary Grid
CAE, CPRE, CCS_Plan F_2012 Summary Grid
CAE, CPRE, CCS_Plan G_2012 Summary Grid

Children’s Health Insurance Program Notice
Patient Protection Notice
Notice Lifetime Limit No Longer Applies and Enrollment Opportunity
HIPAA Rights
Grandfathered Notice
Dependents Notice
Choctaw_Plan A_2011 Summary Grid
Choctaw_Plan B_2011 Summary Grid
Choctaw_Plan C_2011 Summary Grid
Choctaw_Plan D_2011 Summary Grid
Choctaw_Plan E_2011 Summary Grid

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)
Plan Summary (new)
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
404(c) Notice
Summary Annual Report
Understanding Investing (Investor Profile Quiz Included)
Retire View Asset Allocations
Russell LifePoints
Principal LifeTime Portfolios
Redemption Fee & Transfer Restriction
Fund Transfer Restrictions
Retirement Plan Check-Up
Educational Materials
Retirement Savings Worksheet
Principal Termination Contact*
Principal Account Access

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@choctawarchiving.com

           Original paperwork must be mailed to:
           CAE-CPRE 401(k) 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