Benefit Forms

(01)

Cummins_Blue-Cross-Blue-Shield-OK_1

Health Insurance

click on the form to view/download

Your Health Care Benefits
BAM for Members flier
Summary of Benefits & Coverage
Enrollment
COB Questionnaire Form
OK Group Well onTarget

BCBS Covered Preventive Care Services
TELADOC Welcome Flyer
TELADOC New Member Flyer
TELADOC How to Add Dependents
Teledoc Register Before You Need Care flyer
OK Group Provider Finder Member Flier

Visit BCBS of OK

(02)

Cummins_Delta-Dental_2

Delta Dental

click on the form to view/download

Enrollment/Eligibility Update
Enrollment/Eligibility Update - Spanish
Delta Dental EyeMed Summary
Summary Plan Description
Spotlight

Visit Delta Dental of OK

(03)

Cummins_VSP_Logo_New-1

VSP Vision Care

click on the form to view/download

Enrollment Form with Dependent Data
Benefits Summary Overview

View VSP Doctor list

(04)

Cummins_Prudential_Icon_1

Prudential - Life Insurance

click on the form to view/download

Enrollment Form - Spanish
Enrollment Form
Coverage Information
Evidence of Insurability Form - Spanish
Evidence of Insurability Form
Short Form Health Statement - Spanish
Short Form Health Statement

Prudential Account Log in

(05)

Cummins_Bank-of-Oklahoma_Landscape_1

BOK Financial

BOK Account Log in

Employee Workshop Form