Home > Support Ministries > Bethany Benefit > Resources and Forms

This page is a resource page of forms and other documents that may be needed throughout your time with Bethany Benefit Service.

Bethany Benefit Service Resources:

General Resources:
Group Benefit Program 2008
2008 Rates
2008 Rate Announcement

Plan change request forms:
ACH- Funds Transfer Letter and Form
Termination of Insurance or Employment Form
Waiver of Health Insurance Form
Family to Single Dependent Termination Form
Single to Family Dependent Addition Form
Student or Spouse Termination Form
Students or Newborns Dependent Addition Form

* To obtain a Bethany Benefit application, please contact your local conference office and request an enrollment packet. 

Provider claim forms:

Medical Claim Form
Medical International Claim Form
Dental Claim Form
Vision Claim Form
Prescription Claim Form
Prescription International Claim Form

Express Scripts Formulary Information:

2008 Formulary
2008 Medicare Formulary Description