DioCal Employee Benefits

The shortcut address for this page is www.diocal.org/employeebenefits

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Benefit Enrollment or Waiver Forms

2017 Personnel Data and Benefits Eligibility Form (to be used for all new hires and for any changes to personal data or employment status)
2017 Medical and Dental Enrollment / Change Form
Waiver of Medical/Dental Coverage for ACA Marketplace Coverage​
Waiver of Medical/Dental Coverage for Other Non-ACA Coverage
Salary Continuation (unemployment) Benefits Information and Application
2017 Termination Packet
 


Benefit Plan Information/Customer Service

The following benefits are administered by the Episcopal Church Medical Trust. For more detailed information on plan design and policy information visit: www.cpg.org. For enrollment confirmations or general benefit questions the ECMT Client Engagement Center can be reached at 800.480.9967 (8 a.m. to 5 p.m. Pacific time)

Welcome to the 2017 DioCal Employee Benefits Program

2017 Benefit Rates
Employee Assistance Plan Brochure (For more information, visit www.cpg.org)
Additional benefits for medical plan participants:
        — Prescription drugs
        — Mental health
        — Vision
        — Hearing aids
        — Travel assistance
        — Your Health Advocate


Disability Benefits (Lay employees)

Liberty Mutual effective 03/01/2017
Website: mylibertyconnection.com (Company Code: CPG-EE)
Phone: 1-877-225-1740
Short-Term Disability Insurance Summary of Benefits
Long-Term Disability Insurance Summary of Benefits
Reporting Your Disability Claim


Unum Short & Long Term Disability Contract Terminated: 02/28/17

All claims in process with Unum as of 02/28/17 remain with Unum

Lay employees are provided coverage with Unum
Short & Long Term Disability Policy #:407352
www.unum.com
General questions: 800.275.8686
Claims: phone 866.224.9402 or fax 800.447.2498
Unum disability policy certificate
Short term disability benefit summary
Long term disability benefit summary
How to file short term disability claim by phone or web
Short term disability claim form
Long term disability claim form


Clergy Disability with Church Pension Fund

Customer Service: www.cpg.org or 1.800.480.9967


Life Insurance $50K Group Term

(no enrollment form required — coverage automatic to employees working 30 or more hours per week)
Change of Elected Beneficiary Designation form (call 1.800.480.9967 for personal policy ID and return form directly to Church Life Insurance)
Summary of Group Life and Supplemental Group Life Insurance


Retiree Benefits with Church Pension Group

Customer Service: www.cpg.org


Healthcare Compliance Notices


Long Term Care Insurance provided by UNUM

LTC is offered to full-time employees but is not employer paid. Enrolled employees are responsible for the monthly premiums. For information packet and enrollment materials please send email to sarahc@diocal.org to request materials.