Information Technology Security Incident

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Capital Health Benefits Central

Your Rights and Protections Against Surprise Medical Bills

No Surprises Act Notice: Please click on the link to view:

On November 12, 2020, the Departments of Health and Human Services, Labor and the Treasury finalized the Transparency in Coverage Rule that requires health insurers and group health plans to post publicly available machine-readable files that include in-network negotiated payment rates and historical out-of-network charges for covered items and services. Our health plan administrator, Aetna, creates and publishes the machine-readable files on behalf of Capital Health. To link to the Machine-Readable Files, please click on the URL provided:

Welcome to Capital Health Benefits Central, your central resource for benefit information and frequently requested forms. Whether you are experiencing a family status change, require a claim form, or perhaps need to locate an Inner Circle Capital Network Provider, it's all right here. Please visit this site regularly as benefits updates will be posted. If you are in need of a form or website that you do not see below, please contact the benefits department at 609-394-4331 or 609-394-4289.

Click on a link below to download.

Online forms

403(b) Frequently Asked Questions
Aetna Medical Claim Form
Aetna (Payflex) FSA Claim Form
Aetna (Payflex) FSA Direct Deposit Authorization
Benefit Status Change Form
Carebridge Employee Assistance Program - Summary Plan Description
Delta Dental ID Cards
Delta Dental Student Verification Form
Dental Claim Form
Disabled Student Attending Physician's Statement
Drexel Online
Educational Assistance Request Form
Empower Retirement Hardship Withdrawal Request
Empower Retirement Loan Application
Empower Retirement Beneficiary Designation
Empower Retirement Website (
Empower Rollover Into the Plan Form
Empower Withdrawal Request: In-Service Distribution
Empower Withdrawal Request: Separation from Employment
Enterprise Rent-A-Car
Express Scripts Claim Form
Eyemed Vision SPD
Hyatt Legal Plan
New Jersey Manufacturers Insurance
Pension Beneficary Designation Form
PHit Rewards Application and Requirements
Quick Charge Form
Request for Continuation of Medical Coverage for Disabled Student or Handicapped Child
Solicitud de Beneficios Medicos (Medical Benefits Request, Spanish)


Capital Health Benefits
Carebridge CH Employee Portal (Access Code= TW585)
Delta Dental