SBCs, Forms & Legal Docs

Health Care

• Health Care FSA Claim Form

Dependent Care

• Dependent Care FSA Claim Form

• Family Building Benefit Request for Reimbursement
  (accessible only from the BMO network)
• Family Building Benefit Operating Procedure
  (accessible only from the BMO network)
• Sir Vincent Meredith Application Fund Form

• BTA Policy Schedule
• How to File a Leave of Absence or Disability Claim
• Request for Maternity Leave Form
• Request for Parental Leave Form
• Short-Term Disability/Family Medical Leave Checklist

Medicare Special Enrollment

• Request for Employment Information Form
  (CMS-L564)

• COBRA Continuation of Rights
• Creditable Coverage Notice
• Employee Rights Under FMLA
• HIPAA Notice of Privacy Practices
• VSP Notice of Privacy Practices
• Marketplace Health Insurance Coverage Options Notice
• Notice of Special Enrollment Rights
• Medicaid and the Children’s Health Insurance Program (CHIP)
• Women’s Health and Cancer Act of 1998
• Notice for Illinois Employees

• Life and Accident Legal Notices

401(k) Savings Plan

• 401(k) Annual Fee Disclosure
• Safe Harbor Notice of Plan Provisions
• Summary Annual Report
• Qualified Default Investment Alternative Notice
• 401(k) Plan Automatic Enrollment Notice

BMO U.S. Pension Plan

• Annual Funding Notice
• Annual Return/Report of Employee Benefit Plan
• Single-Employer Defined Benefit Plan Actuarial Information