Insurance Forms
(Depending on which web browser you are using, you may need to download the form(s) to your computer BEFORE you are able to type directly onto the form(s).)
Premium Only Plan Form Use this form if an event warrants (i.e., marriage, divorce, birth, etc.) changes to your current insurance plan elections (Medical, Dental, or Vision).
MRP Enrollment Form Medical Reimbursement Plan (MRP) participants (current and new) should email this enrollment form to hr@iecc.edu
MRP Claim Form 2025 IF you chose the Medical Reimbursement Plan, use this form for Claims. Claims must be submitted within 6 months from the date services were incurred.
For the first claim of the year, you will be required to submit a paper claim form. After that, you will be able to set up an online TerrillFLEX account. This is not required, but can be a convenient way to submit and track your claims.
Submit a Claim Use this Reliance Standard portal for any of the following:
-
File a Long-Term Disability Claim
-
File an Accident Claim
-
File a Critical Illness Claim
-
File a Hospital Indemnity Claim
-
File a Supplemental Term Life and AD&D Claim