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Premium Maintenance While Awaiting LTD Forms

Forms applicable to BCNU represented nurses:

• Authorization Form
• Benefits While Awaiting LTD Form: Single Rate
  Use this form when there is one prorated daily premium rate over the course of the reimbursement period.
• Benefits While Awaiting LTD Form: Multiple Rates
  Use this form when there is more than one prorated daily premium rate over the course of the reimbursement period (for example because the reimbursement period spans a point in time where the premium rates have changed – January – MSP, April – HBT).

Forms applicable to HSA represented nurses:

• Authorization Form
• Benefits While Awaiting LTD Form