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Forms

Flex Forms


The following forms are for flex plans.

Premium Conversion Plan Salary Redirection Form
Question and Answer Form
Flex Enrollment Form
Flex Medical Claim Form
Flex Dependent Care Claim Form

Enrollment Forms


The following forms are used for new enrollments.

Enrollment Form
Required Notice Form
Additional Florida Enrollment Form
New Employee Form
Spouse Eligibility Form
HSA Eligibility Form

COBRA/HIPAA Forms


The following employer forms are used if we perform COBRA/HIPAA services for the employer.

Qualifying Event Form
HIPAA Certificate Form

Medical Forms


The following forms are used for medical plans.

Claim Form
Medical Appeal Form
Disability Claim Form
Disability Release To Work Form
Medical History Form
BRCA Information Form
Release Form