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Farm Credit Foundations
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Resources • Forms

Enrollment Form

Status Change Form

Medical and Dental Forms

Access medical claim form from via BlueCrossBlueShield of Illinois' site

Access dental claim form via Delta Dental of Kansas' site

Life Insurance and Accidental Death & Dismemberment Forms

Life Insurance Information is available at www.LifeBenefits.com. To access online life insurance elections or changes view the Enrollment Booklet.

Employee GUL
Spouse GUL

Group Universal Life Service Request Form. This form is used to decrease or cancel GUL coverage or to elect, change or cancel GUL cash accumulation contributions.

Optional Basic Employee Term Life and AD&D election form. This is used to elect additional life insurance for yourself.

Child(ren) Term Life. This form is used to elect child(ren) term life. Please return the form to Farm Credit Foundations at 375 Jackson Street, St. Paul, MN 55101

Beneficiary Designations: Online | Hard Copy

Conversion Form. This form is used if you plan to be the owner of your child’s life insurance policy.

Life Insurance Conversion Form. This form is used to continue life insurance if you retire or leave the company.

Prescription Drug Forms

Caremark Prescription Claim Reimbursement Form is used for reimbursement when you pay the full cost of a prescription.

Caremark Prescription Patient Profile/Mail Order Form is used to initiate the mail order program through Caremark.

Vision Forms

VSP Non Provider Claim Form is used if you see a non Vision Service Plan provider and need to submit a paper claim.

Long Term Disability Insurance

LTD Conversion is used if you would like to convert your Long Term Disability Coverage.

Private Health Authorization Form

Authorization for the Release of Protected Health Information is used to access private health information.

Understanding the W2 form

Get an explanation of the W2 form.

Retirement Savings Plans

AMERITRADE Plan Participant and Plan Trustee Account Form – Options Application

Need to make or update your beneficiary designations? You can do so online with the plan record keeper, New York Life Retirement Services at www.bcomplete.com.

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