Self-Service Forms

General Documents
COBRA Group Coverage Continuation Notice
Creditable Coverage Guidance and Model Disclosure Notices to Use After January 1, 2009
Domestic Partner Registration and Affidavit
Employee Application Form
Existing Group Change Form
State Group Coverage Continuation Notice
Waiver of Group Coverage
ACH Authorization Agreement

Group Reporting Forms
Authorization To Release Group Health Information
Designation Of Representatives
Summary Health Information Request

Spanish Forms
Creditable Coverage Guidance and Model Disclosure Notices to Use After January 1, 2009
Employee Application Form