Lourdes Associates
Human Resources Links / Forms
W-4
Change in Employee Information
Direct Deposit
Vehicle Registration Change
Tuition Reimbursement
Benefits Links and Forms
Enrollment Form
Enrollment/Status change form for 2012 Medical, Dental and Vision Plans.
Medical Insurance
For a list of medical providers and facilities, visit the First Choice Provider website.
For access to your Explanation of Benefits (EOBs), visit the Loomis Company website.
Wellness Plan - My Pathway to Health
With Strategic Health Service’s My Pathway to Health, you will receive personalized support to help you maintain or improve your health.
• Complete your Health Risk Assessment (HRA)
• Interact with a Health Coach
• Take Wellness Plan Online Classes
• Utilize Trackers
• Online Medical Library
For details regarding the Wellness Plan, please download the Wellness Plan Agreement.
If you see a non-preferred provider, please use this Medical Claim Form.
Dental Insurance
For a list of PPO Dentists, please visit the Delta Dental website.
Online Pharmacy
See below to download the materials for the mail order pharmacy, Medvantx.
Vision Service Plan
To view providers, benefits, and when you are eligible for your next exam/hardware please visit www.vsp.com
Flexible Spending Accounts
Visit the ADP Website for complete information about flexible spending accounts for health or dependent care. You may also download one of the claim forms below.
Change in Family Status
To change a benefit during a calendar year there must be a qualifying event (i.e. Marriage, Divorce, Birth, Adoption, Loss of coverage) and file the Lourdes - 2012 Family Status Change Form within 30 days of the event. Otherwise the associate will need to wait until the annual open enrollment.
Leaves of Absence and FMLA
It is the policy of Lourdes Health Network to provide Family and Medical leave benefits in accordance with the State of Washington Family Leave Act of 1989 and the Federal Family Leave Act of 1993. FMLA requires covered employers to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for certain family and medical reasons.
Employee Forms - FMLA
These forms are for an associate who needs to take Family Medical Leave (Medical) for themselves. The associate has to work for Lourdes for one year a work over 1,250 hours in that time frame.
Family Forms - FMLA
These forms are for an associate who has worked at Lourdes for one year and over 1,250 hours who needs to take time off to care for the associate's lawful spouse; biological, step, adoptive or foster, parent or child; or parent-in-law, with a serious health condition.
Employee Forms - NON FMLA
These forms are for an associate who DOES NOT qualify for FMLA (see above) but needs to take a medical leave for themselves.
Retirement Savings Plan (403b and 401a)
Ascension Health recognizes that the individuals who work in its Health Ministries are the primary means by which its mission is accomplished. In appreciation for your long-term contribution to the mission, Ascension Health and Lourdes have established a Retirement Program to assist you in meeting your retirement needs.
Ascension Health is transforming healthcare to provide the highest quality care to all with special attention to those who are poor and vulnerable. We are proud of our 113,000 associates serving in more than 500 locations in 19 states and the District of Columbia. Before long, current and recent editions of Inside Ascension Health will be available in the Communications section of www.MyAscensionHealth.org.
Life Insurance, Accidental Death & Dismemberment (AD&D), and Long-Term Disability (LTD)
Paid Time Off Cashout Requests
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