Columbus County Schools Employee Benefits

All forms must be submitted to Employee Benefits Department

Jan Bartley, Employee Benefits Representative
Email

Commonly Used Forms
(Please note that most of these forms will allow you to type-in information)

 

Workman's Comp Forms (password protected)
Authorization for Release of Information.pdf
Employee Accident Report.pdf
Employee Medical Authorization.pdf
Form 18.pdf
Form 19.pdf
PharmacyForm.pdf
Pharmacy-PhysiciansReport.pdf


General Use  Forms


Amerflex Travel Reinbursement Claim Form.doc
Ameriflex Address-Name Change.doc
Ameriflex Change of Status Form.doc
Ameriflex Spending Account Claim Form.doc
Assurant Dental Cards
Assurant Dental Claim Form.pdf
Voluntary Dental Enrollment Form
Authorization Agreement for Direct Deposit
Colonial Insurance Request for Service.pdf
Colonial Insurance-Claim Form.pdf
Colonial Insurance-How To File A Claim.pdf
COLUMBUS COUNTY SCHOOLS Donated Leave Form
Columbus County Schools Retirement-Resignation Form.pdf
Voluntary Dental Plan Highlights
NC Retirement System- Application for Retirement Contributions Refund.pdf
NC Retirement System-Name Change-Beneficary Change.pdf
State Health Plan Other Coverage Form.pdf
State Health Plan Prior Coverage Form.pdf
Superior Vision Claim Form.pdf
NC-4 Employee Withholding Form-1.pdf
State Health Plan Change Form-1.pdf
State Health Plan Medical Claim Form-1.pdf
Federal W4 Withholding Form-1.pdf
State Health Plan Change Form.pdf
State Health Plan Prescription Drug Claim Form.pdf
 

 

 

401K Information

www.retirement.prudential.com/ncplans/forms/index.htm

 

 

Contact Info


 
Retirement Department of State Treasurer 1-877-627-3287  
  North Carolina Retirement System Division 1-919-733-4191  
  325 North Salisbury Street www.nctreasurer.com Internet Access
  Raleigh, NC 27603-1385    
Health Insurance State Health Plan of North Carolina 1-800-422-4658 Customer Service
  PO Box 30111 1-919-765-7080 Fax
  Durham, NC 27702 www.statehealthplan.state.nc.us Internet Access
       
  North Carolina Smart Choice PPO Plan 1-888-234-2416 Customer Service
       
       Prescription Drug Manager (Medco) 800-336-5933 Customer Service
Employee Benefits  Jan Bartley 1-910-642-5168  
Representative Columbus County Schools Extension 2004  
  PO Box 729 1-910-641-3310 Fax 
  Whiteville, NC 28472 jbartley@columbus.k12.nc.us Email Address
Flexible Benefits Plan  Pierce Group Benefits 1-919-577-0700 Office
ColonialAdministrator 4928 Linksland Drive, Suite 201 1-888-662-7500 Customer Service
  PO Box 1030 1-919-577-0710 Fax
  Holly Springs, NC 27540 www.piercegroupbenefits.com Internet Access
Flexible Spending Accounts AMERIFLEX 1-888-868-3539 Customer Service
  303 Fellowship Road, Suite 201 1-888-868-9363 Fax Claims
  Mount Laurel, NJ 08054 www.flex125.com Forms
    www.theflexcard.com Debit Card Accounts
Disability/Accident/ Colonial Insurance Company 1-800-325-4368 Customer Service
Cancer/Critical Illness PO Box 100195 1-800-880-9325 Fax Claims
  Columbia, SC 29202-3195 www.coloniallife.com/home/ Internet Access
Dental Insurance Assurant -Dental Insurance 1-800-442-7742 Customer Service
  PO Box 2940 1-612-920-4577 Fax
  Clinton, IA 52733    
Vision Insurance Superior Vision Company 1-800-507-3800  
  Member Services/Claims Administration  www.superiorvision.com Internet Access
  PO Box 967    
  Rancho Cordova, CA 95741    
Term Life Insurance Mutual of Omaha-Term Life Insurance 1-800-775-8805 Customer Service
       
Supplemental Retirement NC 401(k) Processing Center 1-866-624-0151 Customer Service
  PO Box 5340 1-570-340-4328 Fax
  Scranton, PA 18505-5340 www.nc401k.prudential.com Internet Access