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Benefit Plan Information and Forms Select a document from the menu tree below. All forms require the Adobe Acrobat Reader. Desoto Enrollment Options 2012 Medical Special Enrollment Rights Form - declination Prior Concurrent Coverage Affidavit BlueCare 16 Benefit Summary 2012 Plan B 3748 Benefit Summary 2012 BCBS Plan Comparisons Blue Medicare 2012 Medicare Rx 2012 BCBS Home Page Life Policy Information Benefits At A Glance Ft Dearborn Life Rates up to $170K Portability Form Dearborn National Home Page Dearborn EOI Combo Dental Plan Information Vision Plan Information Disability Aetna Disability Effective 01/01/2012 Plan Information Physicians Statement Employee Request HIPAA Authorization Claim Form Available with Aetna Disability Plan Only Legal Reference Brochure Employee Assistance Program Card Employee Assistance Program Brochure Critical Illness Plan Information Additional Information Underwriting Guide Accelerated Benefit Application EMCNL Home Page Reimbursement Plans NBS Reimbursement Plans Effective 01/01/2012 Flex Brochure Web Access and Claim Entry Instructions FSA Claim Form Dependent Day Care Expense Worksheet Dependent Day Care Receipt Submission Form Orthodontic Expense Worksheet Electronic Submission Claim Form Hospital Indemnity Plan HIP Plan Information American Public Homepage AFLAC Accident Claim Form Accident Wellness Claim Form Cancer Wellness Claim Form Hospital Wellness Claim Form Sickness Claim Form		Enrollment Links Employee Login Enrollment Instructions Administrator Login Quick Links > NBS Flex D M Administration Services, Inc. 941-492-3664 phone 941-492-3665 fax Email D M Administration
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