Administrative Manual & Forms

Group Administrative Manual

Authorization for Disclosure of Protected Health Information

Group EFT Authorization/Change Form

Group Enrollment/Change Form with Waiver

Spanish Group Enrollment Form

Medical Transition of Care Form

Pharmacy Transition of Care Form

Spanish Waiver Form (for prospective groups)


Domestic Partner Forms
Certification of Domestic Partnership

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 October 15 of each year.

Visit the Centers for Medicare & Medicaid Services for guidance and documents relating to Creditable Coverage requirements for employers.