Employee-Resources

The following forms apply to employees of Catholic Charities Administration and St. Francis Community Services.  Other agencies may have customized forms for local use or supplements to the handbooks.  Please check with your agency’s Human Resource Administrator or Les Lexow, Senior Director of Human Resources, Catholic Charities, 314.367.5500 x 5914 or llexow@ccstl.org with any questions.

Catholic Charities Employee Handbook Revision date February 2013
Key Changes for Handbook 2013 Outline to use with printed version date of 2010 to bring current
Acknowledgement/signature pages from Employee Handbook Forms to be signed and submitted to personnel files acknowledging receipt of handbook information/access
Catholic Charities Volunteer Handbook
Acknowledgement/signature pages from Volunteer Handbook Revision date February 2013
Volunteer Application Forms to be signed and submitted to acknowledge receipt of handbook information/access
FY15 Benefit Plan Information
Employee/Employer Rates Monthly rates for healthcare, dental and basic life insurance options
FY15 UHC Plans
Comparison Chart Compares plan deductibles, out-of-pocket maximums and co-pays
Standard Plan Summary Summary of benefit provisions
Standard Plan Outline Outline of benefits and coverage
Standard Summary Plan Document Informational document
Premier Plan Summary Summary of benefit provisions
Premier Plan Outline Outline of benefits and coverage
Premier Summary Plan Document Informational document
Employee Wellness Form For Premier Plan participants, must be completed by April 30, 2015
Healthcare Election/Change Form To enroll, change address, change dependents and/or beneficiaries
Healthcare Insurance Marketplace Coverage Provide a copy to all new hires per the Affordable Care Act
FY15 Dental Plan
Dental Plan Overview Benefits outline and FAQ
Delta Dental Summary Plan Description Informational document
Delta Dental ID Cards Temporary cards for participants
FY15 UNUM Life Insurance
UNUM Life Coverage Outlines coverage for participants
UNUM Summary Plan Description and Amendment Informational document
Flexible Spending Accounts
FSA Election Form To enroll and/or make changes
FSA Plan Summary Plan overview
FSA Q&A Plan information and Q&A
FSA Customer Service Customer service contact information and online claim filing
Health Care Claim Form
Dependent Care Claim Form
FSA Summary Plan Description Informational document
Hartford Voluntary Life Insurance
Hartford Plan Summary Summary of plan provisions
Personal Health Application Form required for any enrollments after initial eligibility
Hartford Enrollment/Change Form Use form to enroll, elect changes and/or change beneficiaries
Hartford Policy Informational document
Mutual of America (MOA) 403b Thrift Plan 403b Thrift Plan for CC Central Office, CCCS, CFS, QOPC, SMH, SPC
Enrollment Form To open account with MOA and permit investment of match and/or contributions
Beneficiary Change Form To change account beneficiary(ies)
Contribution Election Form To elect to contribution to investment options
Rollover Form To roll (move funds into or out of) funds to MOA or out of MOA
Termination Form To cancel account participation
Summary Plan Description Informational document
Mutual of America (MOA) Life Insurance
Enrollment Form To enroll for coverage
Beneficiary Designation Change Form To change beneficiary(ies)
UNUM LTD
LTD Plan Summary Summary of plan provisions
Submitting a Claim Brochure Information on filing a claim
FMLA FORMS AND INFORMATION For more information, see the government website at:   http://www.dol.gov/whd/fmla/
FMLA Fact Sheet #28 Basic information on FMLA benefits and requirements
WH 380 E (Certification of Health Care Provider for Employee’s Serious Health Condition) Section of form completed by employer, employee and health care provider to confirm need for leave
WH 380 F (Certification of Health Care Provider for Family Member’s Serious Health Condition) Section of form completed by employer, employee and health care provider of patient to confirm need for leave to care for family member
WH 381 (Notice of Eligibility and Rights & Responsibilities) Form employer may use to advise employee of eligibility for FMLA covered leave
WH 382 (Designation Notice) Form employer may use to advise employee of status of requested leave
WH 384 (Certification of Qualifying Exigency for Military Family Leave) Section of form completed by employer and employee to confirm need for leave to care for military family member
WH 385 (Certification for Serious Injury or Illness of a Current Service member —  for Military Family Leave Form for employee/service member and health care provider to complete to request leave
WH 385 V (Certification for Serious Injury of Illness of a Veteran for Military Caregiver Leave Form for employee, veteran and health care provider to complete to request leave for employee to care for military member