Forms

Benefits

For the various forms below, you will need Adobe Acrobat Reader to view and print the forms. If you need help completing a form, bring the blank form into one of our local branch offices or call us directly.

Unsure if you qualify? View Benefits FAQS

Q: Who can I enroll?
A: In addition to you, dependent coverage is offered in the medical, dental, and term life plans. Your eligible dependents are your lawful spouse and your unmarried children (who depend on you for support) from birth through age 18, through age 24 if a full-time student, or through any age if handicapped and unable to earn a living.

Q: When does coverage begin and end?
A: Your coverage is effective on the first day of the month after you enroll, provided you are eligible.


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Benefits for New Employees





Download our Benefits Enrollment Kit
Benefit Enrollment Form Lakeshore's Benefits Enrollment Kit 234 kb
Download Lakeshore's benefits enrollment kit. This kit contains all the necessary forms for participation in the benefits package offered by Lakeshore if you qualify.




Download our Credt Card Authorization Form
Credit Card Authorization Form Credit Card Authorization Form 29 kb
Download Lakeshore's Credit Card Authorization form. Use this form to authorize Lakeshore to charge your credit card for benefits participation.




Download our Temporary Insurance Card Form
Temporary Insurance Card Form Temporary Insurance Card Form 75 kb
Download the temporary insurance card for those that have elected for medical benefits. Use this to card until you receive your regular medical insurance card in the mail.

Download our Temporary Insurance Card Form
Temporary Insurance Card Form Temporary Insurance Card Form 75 kb
Download the temporary insurance card for those that have elected for dental benefits. Use this to card until you receive your regular dental insurance card in the mail.

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