RESOURCES

Forms and Information

Find all benefit carrier related forms and pertinent information.

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Powell’s Benefits Self Service – Oracle

Current Employee Benefits Enrollment Process Quick Reference Guide

New Hire Benefits Enrollment Process Quick Reference Guide

Medical and Prescription

BCBSTX – Medical Claim Form

BCBSTX – Prescription Reimbursement Claim Form

BCBSTX/Express Scripts – Home Delivery Order Form

BCBSTX – Fitness Program Membership

Understanding your EOB

Freestanding Emergency Rooms vs Urgent Care Centers

Medical Term Glossary

MDLIVE Telemedicine

Airrosti Musculoskeletal Rehabilitation

Adult Preventative Care Schedule

Child Preventative Care Schedule

Perinatal Wellness Guidelines 

Machine Readable Files

Fidelity Medicare Services

2025 SBC – Medical PPO Plan

2025 SBC – Medical Premier CDHP

2025 SBC – Medical Basic CDHP

Flexible Spending Accounts and Health Reimbursement Arrangement (HRA)

 TSP – How to file an FSA claim and form

TSP – How to file an HRA claim and form

 TSP – Orthodontia Form

TSP – Dependent Care FSA Form

 TSP – Debit Card Substantiation Instructions

Dental

Cigna Dental Claim Form

Cigna Dental Summary of Benefits

Vision

VSP – Out-of-Network Reimbursement Claim Form

Supplemental Health Benefits

Voya/Powell Microsite 

Accident Insurance Plan

Voya Accident Insurance Brochure & List of Covered Accidents

Voya Travel Assistance Flyer

Voya – How to File a Claim Flyer

Critical Illness Insurance Plan

Voya Critical Illness Brochure & List of Covered Conditions & Diagnoses

Wellness Credit Benefit Flyer

Wellness Credit Benefit –  Claims Checklist & FAQs 

Employee Assistance Program (EAP)

Employee Assistance Program (EAP) Information

Business Travel Medical and Emergency Services
Powell Reference Guide for Business Travel Medical

GeoBlue – Medical Expense Claim Form (Business Travel Only)

Personal Travel Assistance and Emergency Services

Sun Life Travel Assistance

Life and AD&D Insurance

Sun Life – Employee Life Insurance EOI Guide

Sun Life – Employee Online EOI Instructions

Disability

Sun Life – How to file a Leave/Disability Claim Instructions

Sun Life – Enhanced Online Claim Submission

401(k) Plan

Fidelity 401(k) Distribution of Benefits

Fidelity Roth Flyer

Fidelity 401(k) Beneficiary Designation Form

Fidelity – Powell 401k FAQs & Rollover Form