Forms

Forms

There are separate applications for nonprofit members and for-profit members. Please complete either the Nonprofit Employer Application for Membership in the Catholic Benefits Association or the For Profit Employer Application for Membership in the Catholic Benefits Association.

The following is information to help you complete the application:
  • All separately incorporated employers that are affiliated with the applicant (other than parishes) or participants in the plan sponsored by the applicant should be listed on the attachment to the application. These separately incorporated entities (for example, a Catholic charitable organizations established by a diocese or subsidiaries of a for-profit business) must be listed. If an entity is not listed in the application, then that particular employer will not be treated as a member of the Association and will not necessarily be entitled to rely on any favorable judgment obtained in the litigation.
  • The highest officer of the applicant must sign the application. For example, the diocesan bishop must sign diocesan applications. The president of a for-profit business must sign for-profit employer applications.
  • In determining its total number of covered employees for which dues and assessments are payable, the organization may use any reasonable method. Methods that might be used include (i) counting the number of covered employees as of the end of the prior plan year; or (ii) counting the number of covered employees as of the last day of a month preceding the month for which dues are payable, if an employer wishes to more closely reflect the actual number of covered employees from time to time.
  • Once you have completed the Nonprofit Employer Application -OR- the For Profit Employer Application, please email it (including the attachment) to info@lifeaffirmingcare.com. Your application will then be reviewed. Once accepted, you will receive an invoice for the $0.50 monthly dues per covered employee (not to exceed $2,000) and $1.00 monthly temporary litigation fees per covered employee (also, not to exceed $2,000).

Fill Out the Application:
For Nonprofit Employers
For Profit Employers