Claim Forms and Required Notices
- Aetna Medical Benefits Claim Form (PDF, 969 KB)
- Aflac: File a Claim
- Anthem BlueCross BlueShield (PDF, 140 KB)
- Cigna Member Claim Form (PDF, 276 KB)
- Delta Dental Attending Dentist’s Statement Form (PDF, 39 KB)
- Pearson Vision Service Plan (VSP) (PDF, 161 KB)
- Short-term Disability Claim Form – Lincoln Financial Group (PDF, 40 KB)
- Pearson Welfare Benefit Plan (PDF, 1 MB)
- Pearson Benefits Highlights (PDF, 523 KB)
- Pearson Medical Program (PDF, 610 KB)
- Pearson Dental Program (PDF, 379 KB)
- Pearson Vision Care Program (PDF, 367 KB)
- Pearson Flexible Spending Accounts (FSA) (PDF, 432 KB)
- Pearson Long-Term Disability Program (PDF, 392 KB)
- Pearson Life & Accident Insurance Programs (PDF, 434 KB)
- Pearson Important Terms (PDF, 384 KB)
- Pearson Additional Information About Your Benefits (PDF, 540 KB)
- 2025 $400 Deductible PPO Plan (PDF, 728 KB)
- 2025 $900 Deductible PPO Plan (PDF, 719 KB)
- 2025 $1,850 Deductible PPO Plan (PDF, 722 KB)
- 2025 $3,300 Deductible PPO Plan (PDF, 729 KB)
- 2025 $400 Deductible HPN EPO Plan (PDF, 348 KB)
- 2025 $900 Deductible HPN EPO Plan (PDF, 719 KB)
- 2025 $1,850 Deductible HPO EPO Plan (PDF, 343 KB)
- 2025 $3,300 Deductible HPN EPO Plan (PDF, 344 KB)
- 2025 Kaiser – California $3,300 Deductible Plan with HSA (PDF,1.4 MB)
- 2025 Kaiser – California HMO Medium Plan (PDF,1.4 MB)
- Triple S – Puerto Rico (PDF, 325 KB)
- HMSA – Hawaii (PDF, 1.6 MB)
- Pearson Benefits Health Insurance Marketplace Coverage Options and Your Health Coverage (PDF, 215 KB)
- Pearson Benefits Women’s Health & Cancer Rights Act (WHCRA) Notice (PDF, 119 KB)
- Pearson Benefits Newborns’ and Mothers’ Health Protection Act (NMHPA) Notice (PDF, 116 KB)
- Pearson Benefits Premium Assistance Under Medicaid and The Children’s Health Insurance Program (CHIP) (PDF, 212 KB)
- New Jersey Family Medical Leave Act (FMLA) Notice of Change, 2007
- Pearson Welfare Annual Report Summary (PDF, 12 KB)
- Pearson Benefits Creditable Prescription Drug Coverage and Medicare (PDF, 176 KB)