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Benefit Plan Information and Forms Select a document from the menu tree below. All forms require the Adobe Acrobat Reader. Benefit Guide Life Plan Summary Evidence of Insurability Claim Form Conversion Form Portability Form Policyholder Change Form AD&D Plan Summary Claim Form Why AD&D Brochure Axis Global Home Page Medical Enrollment Guide ActiveCare Plan Summary HMO Plan Summary Application Dental Dearborn PPO Dental High Option Plan Summary Low Option Plan Summary Find a Network Provider Humana Discount Dental Plan Summary Humana Home Page Vision Plan Summary Claim Form Provider Nomination Form Find a Network Provider Long-term Disability Plan Summary Claim Form Cancer Plan Brochure Plan Summary Claim Form Policy Change Form Bank Authorization Form Accident Care Plan Summary Plan Rates Claim Form Heart/Stroke Plan Brochure Plan Rates Application Texas Life Plan Summary Change Beneficiary Form Cash Surrender Form Reimbursement Plan Summary Dependent Care Worksheet FSA Claim Form Change of Status Form Dependent Care Claim Form Direct Deposit Form		Enrollment Links Employee Login Administrator Login Enrollment Instructions Quick Links > Financial Benefit Services Financial Benefit Services, LLC 2121 N. Glenville Drive Richardson, TX 75082 Local: (469) 385-4640 Toll Free: (800) 583-6908 Fax: (469) 385-4641 Debbie Walter debbiew@fbsbenefits.com
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