Forms & Documents
At J.J. Stanis and Company, Inc., we make it easy for you to access and submit the necessary forms for your benefits and reimbursements. Below, you’ll find a comprehensive list of forms categorized by benefit type.
Dental
🦷J.J. Stanis Dental Claim Form
🦷Nominate Your Dentist
Excess Major Medical (EMM)
🏥Vision – NVA Claim Form
🏥Vision – Out-of-Network – Davis Vision Claim Form
🏥In-Hospital Claim Form
🏥Excess Major Medical (EMM) Claim Form
Vision
👁 Avesis (GVS) – Out-of-Network Reimbursement Claim Form
👁 J.J. Stanis Vision Claim Form
👁 Vision – Out-of-Network – Davis Vision Claim Form
Flexible Spending (Section 125)
💳Chard Snyder Flexible Spending Account Claim Form
💳J.J. Stanis Dependent Care Reimbursement Form
💳J.J. Stanis Healthcare Reimbursement Form
💳J.J. Stanis Orthodontic Worksheet
Eligibility
📄Student Status Verification Form
📄Change of Beneficiary Form
📄Change of Name Form
📄Change of Address Form
Reimbursement Forms
💼Briarcliff Manor SRP Dental Claim Form
💼EASO Claim Form
💼Middle Country CSD Reimbursement Claim Form
💼Orbit International HRA Reimbursement For
💼South Country CSD Reimbursement Claim Form
ACH ENROLLMENT
💲Automatic Premium Deduction Authorization Form – Health Insurance
💲Norwich Automatic Premium Deduction Authorization Form
💲EEHP Automatic Premium Deduction Authorization Form – Health Insurance
Need Assistance? We’re Here to Help!
If you have any questions or need assistance with your forms, claims, or benefits, our team is ready to support you.
Call us at: (516) 465-3900
Email us at: info@jjstanisco.com