Forms

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Medical

Domestic Partner Affidavit

Health Savings Account

HSA Account Application Form

Supplemental Life & AD&D

The Standard Evidence of Insurability Form*

The Standard Proof of Death Claim Form*

The Standard Accidental Dismemberment Employee’s Statement*

*Return to the Standard

401(k)

401(k) Loan Application

401(k) Rollover Form

401(k) Financial Hardship Form

401(k) In Service Distribution Form

Time Away From Work

Leave of Absence Request Form

Leaves of Absence Guide

The Standard Short-Term Disability Form

The Standard Long-Term Disability Form

Accident and Critical Illness

The Standard Accident Claim Form*

The Standard Critical Illness Claim Form*

The Standard Health Maintenance Claim Form*

*Return to the Standard

Education Assistance

Fischer Homes Associate Education Reimbursement Form

Wellness Program

Primary Care Provider Form

*Return to The Christ Hospital via the WellRight website

Where to submit forms

Unless stated otherwise on the form, please return completed forms to payroll@fischerhomes.com for timely processing.