Important Forms

Access to UPMC for Highmark Members in 2015 1.pdf  

Accident Incident or Injury Report.pdf  

Activities and Room Usage Form.pdf  

Additional Work Duty Form.pdf  

Athletic Contest Workers Form.pdf  

BlankRequisitionSheet - Master 1.xls  

BUDGET CODE LIST 13-14.xls  

CHIP Model Notice 2012-13.docx  

 Daily Conference Request 2017.docx 

Dependent Coverage to Age 26 Notice 4.pdf  

Direct Deposit Form.pdf  Direct Deposit.pdf  

dental claim.pdf  

Educational Trip Pre-Approval Form - Field Trip.pdf  

Employee Exchange Notice.pdf  

Employee Healthcare Selection Form 16-17 1(1).docx

  Employee Healthcare Selection Form 16-17 1.docx  

 Final Accounting Expense Sheet 2017.doc 

 FMLA Leave Form for Employee.pdf  

FMLA Leave Form for Family.pdf  

Guidelines for Public Comment 1.pdf  

HEALTH INSURANCE WITHDRAWL BUYOUT_201605200915_0001.pdf  

HEALTHCARE SELECTION LETTER 2016_201605200954 1.pdf  

Highmark Website Navigation.pdf  

HIPAA Special Enrollment Rights.docx  

Home Language Survey.pdf 

 Homebound Instruction.pdf  

Homebound Teaching Report.pdf 

 Mentor Report Form.pdf  

IPM-2016.pdf  

IPM.pdf  

KM_Salary Reduction Agreement for 403revised.pdf  

  Mileage 2016.xls 

Mileage Reimbursement 2017.xls 

 Newborns Mothers Health Protection Act.docx  

NVA VISION CLAIM FORM.pdf  Notice Lifetime Limit.pdf  

NVA VISION BENEFIT SUMMARY 1.pdf   

Overnight Conference Request 2017.doc 

 Pre-Approval for Credit Reimbursement.pdf 

 Patient Protection Model Disclosure.pdf  

 Physicians Certificate for Medication.pdf 

Promissory Note.pdf 

 Reg Employee Time Sheet.pdf  

Request for Extra Credits Earned Reimbursement.pdf  

Sabbatical Leave Form.pdf  

SICK DAY BONUS-YEA.docx 

 SUMMARY OF BENEFITS COVERAGE OPTION A_201605200936 2.pdf  

Sub Time Sheet.pdf  

SUMMARY OF BENEFITS COVERAGE OPTION E_201605200933 2.pdf  

SUMMARY OF BENEFITS COVERAGE OPTION G_201605200937 3.pdf 

 United Concordia Dental Coverage Information.pdf  

Voya Financial.pdf  WHCRA Notice 1.docx  

WS707 Use of Fac.pdf  

WSUse of Facility2014.pdf