TEAM SRC EMPLOYEE INSURANCE
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REQUIRED NOTICES

You have been directed to this page because you are eligible for insurance, and we are required to inform you of the information in the PDFs below.
​​Button to return to Team Members page is at the bottom of this page.
required notices signature page

Below are latest copies of our Summary Plan Description, CHIP Notice and WHCRA Enrollment Notice.

The Summary Plan Description describes all of our current insurance benefits provided to you and/or your dependents under the Southeast Restaurants Corporation Welfare Benefit Plan.
 
Once you click on each of the PDFs below, they will be downloaded to your computer. You are free to file them electronically or print out a paper copy for yourself.

If you would like a paper copy of this document and do not have the ability to print it yourself, it will be furnished to you free of charge. Please contact HR via email (tashley@srcorp.org), in writing (P.O. Box 3647, Myrtle Beach, SC 2957) or by fax (1-888-462-2749) to let us know if you need a paper copy. Please be sure to include your name.
 
At this point, all employees have already signed an electronic disclosure & consent form, however you can withdraw that consent in writing, and it will be effective two days after it is received by the HR Department. If consent is withdrawn, it will only be effective for those documents not yet issued, and for the documents specified in your written notice.

To withdraw your consent, you must send a written notice with your signature to:
Southeast Restaurants Corp., Attn: Tami Ashley, P.O. Box 3647, Myrtle Beach, SC 29578 or fax to 1-888-462-2749.

Click on each of the links below to download and view.
Summary Plan Description
2020 Special Enrollment Notice

2020 CHIP Notice
2020 WHCRA Enrollment Notice

 You are required to print the Notifications Page below and fax to HR at 1.888.462.1749.
Click on the link below to open. Download to your desktop, print, sign and fax to HR at 1.888.462.2749.
2020 Notifications Page

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2020 BCBS Non-Discrimination Notice
2020 BCBS Certificate of Coverage
2020 Creditable Coverage Medicare Part D HRA9
2020 Creditable Coverage Medicare Part D Secure 2
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