Administrative Manual & Forms

Disclosure Authorization Form

Group EFT Authorization/Change Form

Group Enrollment/Change Form

Spanish Group Enrollment Form

Transition of Care Form

Waiver Form (for existing groups)

Waiver Form (for prospective groups)

Domestic Partner Forms
Indemnification Agreement for Domestic Partner Health Insurance Coverage

Certification of Domestic Partnership

HIPAA Transaction Standard Companion Guide
834 Enrollment and Maintenance

CHIP Notice
Children's Health Insurance Program Model Notice

Offer Prescription Drug Coverage? Please Read!
Does your company offer prescription drug coverage to Medicare- and Medicare Part D-eligible employees? To help these individuals make informed choices about prescription drug coverage, the Center for Medicare and Medicaid Services says that you must provide them with a notice of creditable or non-creditable coverage by November 15.

Disclosure to CMS Form and Creditable Coverage Overview from the Centers for Medicare & Medicaid Services.