LSU First -- The LSU System Health Plan

Forms

  1. Summary Plan Description for the 7/1/11-12/31/11 Plan Year
  2. Policy for HCC Life and AD&D Benefit
  3. LSU First Enrollment Form-GB-01
  4. Beneficiary Designation Form for Term Life Insurance (7/1/2010-6/30/2011)
  5. Critical Illness Direct Cash Benefit Claim Form
  6. Death Claim for Term Life Insurance (7/1/2010-6/30/2011) :: W-9
  7. Guide to CIGNA’s Explanation of Benefits (EOBs)
  8. Life Insurance Conversion Form
  9. Medical Claim Form (CIGNA)
  10. Personal Representative Form (CIGNA)
  11. Physician Nomination Form (CIGNA)
  12. Prescription Drug Claim Form (ESI)