Miguel Morales
Benefits and Leave Specialist
O: 702-383-3848
Delta Point Bldg, Ste 195
Miguel.Morales@umcsn.com

Please complete the following:

OE Switching Health Plans Form
Backup documentation required: Copy of social security card for yourself and your dependents (If applicable), and copies of your certified marriage certificate (If applicable), and birth certificates for dependent children (If applicable).
For Both Plans: Clark County COB Form PPO - EPO

Please complete the following:

Open Enrollment Benefit Packet
Backup documentation required: Copy of social security card for yourself and your dependents (If applicable), and copies of your certified marriage certificate (If applicable), and birth certificates for dependent children (If applicable).

Please complete the following:

OE Waived Benefits Form

Please complete the following:

OE Self Funded PPO / EPO Adding Dependent Form
Backup documentation required: Copy of social security card for your dependents (If applicable), and copies of your certified marriage certificate (If applicable), and birth certificates for dependent children (If applicable).
For Both Plans: Clark County COB Form PPO - EPO

Please complete the following:

OE Self Funded PPO / EPO Remove Dependent form
(If removing spouse, please indicate reason why on other line)

During Open Enrollment, you can increase your supplemental life insurance, by 3 increments (up to $30,000) up to the Guaranteed Issue amount without going through underwriting. If you have do not currently have supplemental insurance or are requesting anything over the guaranteed issue amount, you will need to apply through our office. We will then direct you on how to complete the Evidence of Insurability (EOI) process.

Guaranteed Issue is as follows:
Employee - $250,000
Spouse - $30,000
Children - $20,000 ( during open enrollment, child supplemental life can be added without going through the EOI process)

Accidental Death & Dismemberment (AD&D) – Can be added up to $300,000 during Open Enrollment without going through the EOI process.

If adding supplemental life for the first time for dependents:
Copy of social security card for your dependents (If applicable), and copies of your certified marriage certificate (If applicable), and birth certificates for dependent children (If applicable).

Life Insurance/Summary of Coverage:

To Increase/Decrease Current Supplemental Life
OE Sun Life Application Change Amount for Supplemental Life

This application is if you are not currently enrolled in Supplemental Life
OE Sun Life New Application for Supplemental Life

Sun Life Voluntary Group Term Life Benefit Highlight

Sun Life Voluntary Life Voluntary Insurance Rates

Sun Life Voluntary Accidental Death and Dismemberment (AD&D) – Benefit Highlights

Sun Life Voluntary Accidental Death and Dismemberment (AD&D) Rates

Sun Life Beneficiary Form

Sun Life Evidence of Insurability (EOI) Application

Self Funded

Clark County Self Funded PPO 2024 Plan Document

Medical Provider Directory through SHO (Self-Funded PPO and EPO)

Self Funded PPO Dental Provider Directory through Diversified

Schedule of Self-Funded Dental Benefits

Self-Funded EyeMed Vision Benefits

Teladoc Mobile App

Self-Funded Wellness Benefit Form

2024 CCSF PPO Summary of Benefits and Coverage (SBC)

Dependent Child Affidavit (Self-Funded PPO and EPO)

Navitus Mobile App

Dispatch Health

CCSF and EPO Brochure

EPO

EPO 2024 Plan Document

Medical Provider Directory Through SHO (Self-Funded PPO and EPO)

EPO Dental Providers thorugh SHO

EPO Schedule of Dental Benefits

2024 EPO Summary of Benefits and Coverage (SBC)

Dependent Child Affidavit (Self-Funded PPO and EPO)

EPO EyeMed Vision Benefits

CCSF and EPO Brochure

TASC FAQs

TASC Card Experience

TASC Mobile Experience

TASC Dependent Care FSA Qualifications

TASC FSA Enrollment 2024

Guardian/Trustmark Open Enrollment Information 2024

Counselors Onsite Schedule 2024