Insurance Forms

Southwest Church Connection is pleased to offer the employees of our association of churches the option for group insurance for Medical, Life, Dental and Vision Insurance plans.

Click the link  below for the forms you need:

Blue Cross Blue Shield Application Form

Blue Cross Blue Shield COBRA Application

Companion LIFE Insurance (Basic) Application and Coverage Info

Employer Dental Services Application

EDS 700N with FORM Booklet (update)

EyeMed Vision Plan Application

For more information concerning these plans, call or email:

Laura Brown – 928-445-5225
SWCC / Prescott Pines Business Office
laura@prescottpines.org
 

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