Forms and Publications

Health

• Health Insurance Election Form
• Pretax Premium Waiver Form
• Retiree Health Insurance Election Form
• Surviving Spouse Health Insurance Election Form
• Spouse Program Election Form
  
• Qualifying Status Change Event Form (required to make benefit changes during year)

Health

• PPO Plan Non-Network Claim Form
• PPO Prescription Non-Network Claim Form
• PPO Prescription Mail Order Form

FSAs and HSAs

• FSA/HSA Enrollment Election Form
• HSA Application and Disclosure Package
  

FSAs and HSAs

• FSA Reimbursement Claim Form
• FSA-MRA Letter of Medical Need
  
• FSA-MRA Termination of Employment Form

Group Life

• Group Life Insurance Enrollment Form
• Group Life Insurance Beneficiary Form
• Group Life Short-Form Questionnaire (for Optional Life coverage)
• Group Life Conversion Form
  
• Group Life Portability Form
  
• Qualifying Status Change Event Form (required to make benefit changes during year)
  

Supplemental Benefits

• Accident/Disability Insurance Election Form
• Cancer/Intensive Care Insurance Election Form
• Hospitalization Insurance Election Form
  
• Dental Insurance Election Form
• Vision Insurance Election Form
• Qualifying Status Change Event Form (required to make benefit changes during year)
  

• Benefits Guide for Active State Employees
• Employee Enrollment Readiness Checklist
• Benefits Guide for Retirees
• Retiree Enrollment Readiness Checklist
• Retiree Benefits Package
• Retiree Rate Chart
• Medicare Part D Notice of Creditable Coverage for State Employees
• HIPAA Privacy Notice
• Authorization to Use and/or Disclose Personal Health Information Form
• Guide on Generics
• Guide on Weather Emergencies
• Guide to Improve Health
• Guide to Mail Service
• Guide When Seeing Doctor

• 2010 Tax-Favored Accounts (FSA/HSA)
• 2009 Tax-Favored Accounts (FSA/HSA)

• PPO Plan Booklet and Benefits Document Effective January 1, 2010 (Coming Soon)
• PPO Plan Booklet and Benefits Document Effective January 1, 2007
• PPO Plan Summary of Plan Description Material Modification Effective January 1, 2009
• PPO 2010 Open Enrollment Brochure
• PPO 2009 Open Enrollment Brochure
• RxBenefits at a Glance (Standard PPO)
• RxBenefits at a Glance (Health Investor PPO)

• Minnesota Life Brochure
• SMS/SES Disability Insurance Brochure

• AvMed Health Investor Plan Effective January 1, 2006
• AvMed Standard Health Plan Effective January 1, 2007
• Capital Health Plan Effective January 1, 2006
• Florida Health Care Plan Effective January 1, 2006
• United Healthcare Standard Plan Effective January 1, 2008
• United Healthcare Health Investor Plan Effective January 1, 2008
• Vista Healthplan Effective January 1, 2006

• Ameritas Indemnity with PPO
• Assurant Prepaid/Indemnity with PPO
• CIGNA Prepaid
• CompBenefits Prepaid (Network Plus)/PPO
• CompBenefits Prepaid (Select 15)/Indemnity
• UnitedHealthcare Prepaid (Solstice S700)
• Humana Vision

• AFLAC brochure
• Alta brochure
• Colonial Life brochure
• Philadelphia American Life brochure