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Benefit Highlights

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	Forms

Forms

Included below is a list of forms you may need for various benefits offered by The McGraw-Hill Companies:

Enrollment/Change Forms

Benefits Enrollment and Change Form

Dependent Verification Process and Instructions

Affidavit of Coverage: Qualified Adult Family Member

Affidavit to Terminate Coverage: Qualified Adult Family Member

Domestic Partner Affidavit

Affidavit to Terminate Domestic Partnership

DMO Enrollment/Change Form

Beneficiary Designation Form

Transition of Care Memo and Application

2010 Long Term Disability Benefits Change Form (for LTD participants)

2010 Retiree Benefits Election Form for Changes Only (for retirees)

2010 COBRA Benefits Change Form (for COBRA participants)

Leave Forms

Parental Leave Form

Claim Forms

UnitedHealthcare Medical Claim Form

Medco Prescription Reimbursement Benefit Claim Form

Medco Prescription Mail Order Form

Medco Prescription Fax from Physician Office

The McGraw-Hill Companies Dental Plan Claim Form

FSA: Healthcare Pay Me Back Claim Form (WageWorks)

FSA: Dependent Day Care Pay Me Back Claim Form (WageWorks)

ValueOptions Member Submitted Claim Form

VSP Out-of-Network Claim Form

Commuter Benefits: Pay Me Back Form (WageWorks)

Special Retiree Forms

Medicare Part D Reimbursement Form

Retiree Beneficiary Designation Form (Hartford)