Forms and Policies

Download these forms and policies related to your benefits as an employee of New Hanover Regional Medical Center.

Your Responsibilities

Compensation and Avoidance of Excess Benefits Policy
Employee Illness or Injury (Non Work Related) Policy
Fitness for Duty Policy
Funeral Leave Policy
Jury Duty Leave Policy
Workers' Compensation and Modified Duty Policy

Leave of Absence

Leave of Absence Policy
FMLA Application - EMPLOYEE - Use this form if you have worked here more than one year, have worked at least 1250 hours in the past 12 months,  and you need to take time off for your own serious health condition.
FMLA Application - CARE OF FAMILY - Use this form if you have worked here more than one year, have worked at least 1250 hours in the past 12 months, and you need to take time off to care for your spouse, parent or child up to age 18 with a serious health condition, or for Military Family FMLA.
Other Medical Leave Application - Use this form if you do not qualify for FMLA but need to take leave for consecutive days off due to your own serious health condition.
Leave of Absence Application - Use this form if you will miss more than 10 scheduled shifts due to Personal, Educational, or Military Leave (for Service Members).
Leave Return to Work Process

Health Benefits

Ameritas Dental Claim Form
Ameritas Plan Details Brochure
Community Eye Care Plan
Community Eye Care Out of Network Reimbursement Form
EAP Employee Assistance Policy
Flores Direct Deposit Set Up
Flores FSA Medical Guide Eligible Expenses
Flores No Wait Dependent Care Form
NHRMC Plan Facilities

Life & LTD

Online Will Preparation Brochure
Emergency Travel Assistance and Identity Theft Brochure

More Great Benefits

Adoption Assistance Application
Adoption Assistance Policy
CLC Childcare Reimbursement Form
College Foundation Enrollment Form
College Foundation Enrollment Instructions
College Foundation Payroll Authorization
College Foundation Withdrawal Form
Employee Financial Assistance Application
Employee Financial Assistance Policy
Paid Days Off (PDO) Policy
Paid Days Off Donation Form
Tuition Assistance Application
Tuition Assistance Policy
WOW (Work on Weekends) Policy

Retirement

2015 Medicare Handbook
Directions for Loans and Hardships - VALIC
Pension Estimate Request Form
VALIC Enrollment Form
VALIC Hardship Withdrawal Form

Leaving NHRMC

COBRA Continuation of Coverage Rights
Leaving NHRMC Employee Printable Checklist
Termination of Employment Policy