1. Go to the Health Trans website listed on the back of your healthcare id card.
2. Or see the Human Resources office for a printed copy of the mail order form.
3. Take the form to your doctor for completion.

For medical, dental and vision claims contact:
Delta Health Systems
PO Box 391
Stockton, CA 95201

For hospital claims contact:
Delta Health Systems
PO Box 60007
Los Angeles, CA 90060-0007

Direct questions regarding eligibility to your customer service representative in the Eligibility Department, Charlotte Nichols, at 800-556-7830, extension 3432.

Direct questions regarding benefits or claims to your customer service representative in the Claims Department, Rashawn Robertson, at 800-556-7830, extension 5626.

Customer Service: 800-556-5918
See your Delta Health Systems ID card for more information.

AFLAC funds can be used to help fill in the gaps in your primary health care plan. Usually the policies pay cash benefits directly to you, unless you choose otherwise. A claim form can be downloaded straight from the AFLAC website. The website has a great deal more information on policies, coverage, and claims.

Submit an AFLAC claim

If your health care provider will not submit their own billing, you will have to do so yourself, after you have paid for the service.

1. Get a detailed bill with treatment codes, and the provider's name and business address.
2. Photo-copy the bill and make sure this information is included (from your health care ID card):

1. Employer name
2. Member ID #
3. Employee Name
4. Blue Cross Case #
5. Mail to Delta Health Systems

Medical, dental and vision claims processed by:
Delta Health Systems
P.O. Box 391
Stockton, CA 95201

Hospital claims processed by:
Delta Health Systems
P.O. Box 60007
Los Angeles, CA 90060-007

Direct questions regarding benefits or claims to your customer service representative in the Claims Department, Rashawn Robertson, at 800-556-7830, extension 5626.

Customer Service: 800-556-5918
See your Delta Health Systems ID card for more information.

Some people have been surprised by a request for payment before a pre-scheduled procedure. A financial counselor from the hospital has told them this is how things are now being done. This indeed is how payments for some procedures are now being billed. Rather than billing for your payment, St. Helena Hospital is requesting payment at the treatment date. St. Helena Hospital's financial counselor, Lea Taylor (967-5754), advises calling ahead to make sure what the co-payment is prior to arriving for the procedure. The co-payment is your portion of the charges according to the PUC Health Care Assistance Plan.

The open enrollment period for Hartford supplemental insurance is there for you to assess your level of coverage. If you are happy with the level of coverage, signing the form and returning it to Human Resources acknowledges that. But if you want to make a change the open enrollment period is the time to do so. Remember if you are full-time (38 hours +) you already get 50,000 as a benefit, and the annual acknowledgement needs to reflect the new total, taking into account the initial 50,000. (The sum total is the 50,000 plus the supplemental.)

Richard Gore is your first contact at ext. , or
This is for:

• Mobile Manor
• College housing (Woodside Homes)
• College rentals
• Student housing (college-owned off-campus)

The PUC Benefits Information sheets can be downloaded separately for hourly and salary employees in the HR Forms & Information section.

The Liberty Mutual Insurance Company offers college employees reduced/favorable rates on auto, home, and renters insurance.

Contact Rich Goertzen at 800-251-2799 or www.libertymutual.com/lm/richardgoertzen for more details and quotes.

1. name change
2. address changed
3. add/remove a spouse/dependent child

How to make the changes:

1. Fill out Employee Benefits Change Request form from HR office
2. Return form to HR office

Visit the Hartford Life Insurance Company at www.thehartford.com. A more descriptive site is Adventist Risk Management at adventistrisk.org. Click on Employee Benefits, then select the topic you are interested in.

For eligibility (the benefit to pay out), the employee must complete the beneficiary form, and send a copy to the Human Resources office.

Check out the Howell Mountain Enterprises Employee Benefits document that can be found in the HR Forms & Information section.

The PUC Health Care Assistance Plan allows for a new pair of glasses each year.

The notice board in your department has a poster describing your basic rights and coverage. For more information about SDI and FMLA you can go to the following two websites, which cover, eligibility, how to apply, your responsibilities, your employer's responsibilities, and conditions and restrictions:

U.S. Department of Labor: www.dol.gov (type "FMLA" into the search field)

The California government website: www.edd.ca.gov/direp/dipubtx.htm (You can complete and download a DE2501 form online for SDI or get the form from the PUC Human Resources office. Either way the form must be completed by your doctor before it is sent in to the nearest SDI office.)

Check out the NAD education website, which has a link to employment opportunities: www.nadeducation.adventist.org

The leave application form is now online as well as being available from the Human Resources office.

Check out www.aigvalic.com/adventist and http://www.nadadventist.org/ret/ for more information.

1. Go to AFLAC.com and follow the prompts.
2. Click on POLICYHOLDERS (under "Have Aflac?").
   
3. Click on "Get a Claim Form."

FLEX ONE is listed under Reimbursement Forms and contains details on how to complete the form

Submit an AFLAC claim

1. Go to www.deltahealthsystems.com and follow the prompts.
2. Click on "Useful Forms".
3. Choose from Vision, Medical, Prescription, or Dental Claim forms.
4. See your health care card for Delta Health Systems address and telephone numbers.

1. Go to unum.com and follow the prompts.
2. Click on Employers
   
3. Click on Forms and Reference Materials
   
4. Enter 1335-03 in Search by Form Number
   
5. Click on GO button
   
6. Click on 1335-03
   
7. The form will now display in an Adobe Acrobat window.
8. Click on the print symbol to make a copy

1. Go to the Health Trans website, the address in on the reverse of your health care ID card – or click here https://PUC.lc.healthtrans.com.
2. Log in and follow prompts.
3. If you have not logged in before, follow the prompts to log in for the first time, and make a note of your password

The local representative is Tim Ranuio.
Cell phone: 650-291-1813
Business phone: 707-258-2602