For more information about the benefit plans available to eligible CRI employees, refer to the CRI Highlights Brochure

Making Changes During the Year
Generally, after you've made your plan elections, you may change those only during the next annual open enrollment period. However, changes are permitted if you have
a qualifying event
and notify CRI's Human Resources in writing within 31 days of the event.

Contact Us

Forms

This page contains links to various forms and other plan related information.

Health Care Disability Reimbursement Accounts

Plan Name	Forms/Other Plan Information
Blue Cross Blue Shield of North Carolina	FORMS Blue Cross Blue Shield Enrollment and Change Application Waiver of Group Medical Coverage Form Claim Form - Medical Claim Form - Prescription Drug PLAN INFORMATION PPO Benefit Highlights PPO Summary of Benefits and Coverage PPO Benefit Booklet PPO Quick Reference Contact List Notice of Privacy Practices HIPAA Authorization to Release Information Find a PPO Health Care Professional Pharmacy Services
DENTAL Guardian Dental: -DHMO (CA only) -PPO High Option (CA/NC) -PPO Low Option (NC only)	FORMS Guardian Dental Enrollment Form Claim Form Loss of Coverage Statement - Used when an employee and/or dependent loses coverage under another plan. If the employee has not enrolled for any Guardian coverage, an enrollment form is required. Guardian Dental Wallet ID Card Guardian Dental COBRA Continuation Form PLAN INFORMATION DHMO (CA only) Copay Schedule Certificate of Coverage PPO High Option (CA & NC) Certificate of Coverage PPO Low Option (NC only) Certificate of Coverage OTHER USEFUL INFORMATION Provider Directory
VISION VSP	FORMS Out-Of-Network Reimbursement Form PLAN INFORMATION EOC
BASIC LIFE/AD&D MetLife: -Basic Employee Life -Basic AD&D (same amount as life insurance)	FORMS Enrollment for Group Insurance - Life, AD&D, STD and LTD Beneficiary Designation Statement of Health (refer to Benefit Plans for information on when this form is required) Claim Form - Life Insurance Claim Form - AD&D Conversion Form Portability Form PLAN INFORMATION Basic Life/AD&D Plan Highlights Basic Life/AD&D Certificate Understanding Portability and Conversion brochure
OPTIONAL LIFE/AD&D MetLife: -Optional Employee Life & AD&D -Optional Dependent Life & AD&D (Spouse & Children)	FORMS Enrollment for Group Insurance - Life, AD&D, STD and LTD Statement of Health (Refer to Benefit Plans for guidance on when this form is required.) Beneficiary Designation Claim Form - Life Insurance Claim Form - AD&D Election of Portability Coverage PLAN INFORMATION Plan Highlights for Optional Life/AD&D for Employee, Spouse and Dependent Children Plan Certificate for Optional Life/AD&D for Employee, Spouse and Dependent Children
SHORT TERM DISABILITY MetLife	FORMS Enrollment for Group Insurance - Life, AD&D, STD and LTD Statement of Health (Refer to Benefit Plans for guidance on when this form is required.) Claim Form - Disability (STD/LTD): PLAN INFORMATION STD Plan Highlights STD Certificate
LONG TERM DISABILITY MetLife	FORMS Enrollment for Group Insurance - Life, AD&D, STD and LTD Statement of Health [MORE] Claim Form - Disability (STD/LTD): -Employee Statement -Employer Statement -Physician's Statement PLAN INFORMATION LTD Plan Highlights LTD Certificate
HEALTH CARE REIMBURSEMENT ACCOUNT	FORMS Health Care and Dependent Care Reimbursement Accounts Enrollment Form PLAN INFORMATION Worksheet for Estimating Your Annual HCRA Expenses IRS Publication 502 - Medical and Dental Expenses - Includes detailed information on eligible expenses and whose expenses you can claim under this plan. Not all expenses listed in the publication are eligible; the claims administrator is responsible for making the final determination on eligible claims.
DEPENDENT CARE REIMBURSEMENT ACCOUNT	FORMS Health Care and Dependent Care Reimbursement Accounts Enrollment Form PLAN INFORMATION Worksheet for Estimating Your Annual DCRA Expenses IRS Publication 503 - Dependent & Child Care Expenses - Includes detailed information on eligible expenses and whose expenses you can claim under this plan. Not all expenses listed in the publication are eligible; the claims administrator is responsible for making the final determination on eligible claims.

The information contained here is intended to provide an overview of the various benefit programs available to eligible CRI employees and their families. Since the information contained here consists of summary highlights of the plans, you should refer to the applicable plan documents for the complete terms and provisions (including plan limitations and exclusions). If in any way the information here conflicts with the information in the applicable plan documents, the full plan documents will prevail. The company reserves the right to change these benefits (including, but not limited to, the right to amend, suspend or terminate) or change employee contributions at its discretion at any time and without prior notice.