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Enrollment Forms.
All completed enrollment forms should be sent to our broker:
Resource Equity Group, P.O. Box 5556, Greenville, SC 29606 (fax 864-242-0698)
or emailed to mailbox@regroupusa.com
Use this form to enroll in the health plan with Blue Choice Healthplan and dental plan with Blue Cross.
Complete this form along with your enrollment form.
Use this form to make your payroll deductions "pre-tax"
General Health Insurance Forms
This document outlines the health benefits.
This is a detailed description of your medical coverage.
This is a summary of the benefits that are covered under your plan.
What this plan covers and what it costs
Use this form to let us know if you want to allow someone other than yourself to discuss your health information. This could be your wife or husband, a relative, an attorney and so on.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Use this form to provide information about possible other coverage.
Use this form for filing claims incurred from a non-network provider.
Prescription Drug Forms
With our PDL, you and your doctor have the freedom to choose the medication that works best for you.
List of participating chain and independent retail pharmacies.
This flyer explains how to get the most out your prescription drug plan.
This document lists brand name drugs that have generic equivalents.
Use this form to process prescription drug orders under the mail service plan.
Use this form to obtain reimbursement for a prescription drug.
Dental Coverage Forms
Use this form if your dentist doesn't file claims.
Miscellaneous Forms
Medicaid and the Children’s Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families.
SUMMARIES & FORMS
www.rcmbenefits.com
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BENEFITS Website
©2014 Resource Equity Group
R.C. Molding, Inc.
