Member Forms

We exist to provide ministries and workers like you with health, retirement and disability benefits that align with our Christian faith and values.

As a non-profit partner of the LCMS community that brings together thousands of ministries of all sizes, Concordia Plans is able to offer affordable, quality benefits, as well as business solutions that free up ministries to focus on spreading the Word of God. We are here because of you, for you.

NewEnrollment

New Enrollment

Enrollment Form (11010) (pdf)
DownloadEnrollment Form (11010) (1143 KB)

eSign Forms:

Enrollment Form (11010) - eSign Edition

NewEnrollment

Enrollment and Status Changes

eSign Forms:

Accidental Injury and Critical Illness Enrollment Form (X20709) - eSign Edition

CHP Special Enrollment Application Form (11041) - eSign Edition

Death Notification Form (40153) - eSign Edition

Flexible Spending Account Enrollment Form (HealthEquity) - eSign Edition

Health Savings Account Application (HealthEquity) - eSign Edition

NewEnrollment

Claims

Blue Cross Blue Shield Claim Form (pdf)
DownloadBlue Cross Blue Shield Claim Form (145 KB)
Blue Cross Blue Shield International Medical Claim (pdf)
DownloadBlue Cross Blue Shield International Medical Claim (41 KB)
Cigna Claim - Pharmacy (V583522k) (pdf)
DownloadCigna Claim - Pharmacy (V583522k) (980 KB)
Cigna Claim - Pharmacy Home Delivery (pdf)
DownloadCigna Claim - Pharmacy Home Delivery (53 KB)
Cigna Medical Claim Form (pdf)
DownloadCigna Medical Claim Form (378 KB)
Dental Claim Form - Cigna (V590154) (pdf)
DownloadDental Claim Form - Cigna (V590154) (1839 KB)
Express Scripts Claim (pdf)
DownloadExpress Scripts Claim (76 KB)
Express Scripts Claim - Medicare (pdf)
DownloadExpress Scripts Claim - Medicare (1393 KB)
Express Scripts Home Delivery Order Form (pdf)
DownloadExpress Scripts Home Delivery Order Form (736 KB)
GeoBlue Claim (Medical Expense) (pdf)
DownloadGeoBlue Claim (Medical Expense) (1039 KB)
Kaiser Prescription Claim Form (pdf)
DownloadKaiser Prescription Claim Form (36 KB)
UMR Claim Form (pdf)
DownloadUMR Claim Form (162 KB)
VSP Vision Claim (V10000) (pdf)
DownloadVSP Vision Claim (V10000) (136 KB)

NewEnrollment

Beneficiary Change

CDSP AIP Beneficiary Designation Form - Active Worker (11142) (pdf)
DownloadCDSP AIP Beneficiary Designation Form - Active Worker (11142) (1317 KB)

NewEnrollment

Contact Information Change

Change of Contact Information (11006) (pdf)
DownloadChange of Contact Information (11006) (250 KB)

eSign Forms:

Change of Contact Information (11006) - eSign Edition

NewEnrollment

Contribution Change

ACH Authorization (pdf)
DownloadACH Authorization (286 KB)
CRSP AutoSave Salary Deferral Agreement (11368) (pdf)
DownloadCRSP AutoSave Salary Deferral Agreement (11368) (296 KB)
Salary Deferral Agreement (11381) (pdf)
DownloadSalary Deferral Agreement (11381) (297 KB)

eSign Forms:

ACH Authorization - eSign Edition

NewEnrollment

Direct Deposit

Direct Deposit Authorization - Blue Cross Blue Shield (pdf)
DownloadDirect Deposit Authorization - Blue Cross Blue Shield (92 KB)

NewEnrollment

Legal Documentation

eSign Forms:

Nomination of Benefit Plan Representative (14300)

Taxpayer ID Number Request for Survivor (11395)

NewEnrollment

Seminary Student

eSign Forms:

Enrollment Form - Seminary Student (11023) - eSign Edition

Seminary Student Special Enrollment Form (11026) - eSign Edition

Resource Library

Looking for more than just a form? Visit the Concordia Plans Resource Library to peruse forms, documents, blogs and more.

Access the Resource Library