Forms & Documents
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Disability Insurance - The Standard
Federal & State Required Notices
- Consolidated Omnibus Budget Reconciliation Act (COBRA)
- Creditable Coverage Disclosure Notice
- EEOC Wellness Program Notice
- Family & Medical Leave Act (FMLA)
- Genetic Information Nondiscrimination Act (GINA)
- Health Insurance Portability & Accountability Act (HIPAA)
- Marketplace Model Notice
- Mental Health Parity Act
- Michelle's Law
- Newborns' and Mothers' Health Protection Act
- Notice of Privacy Practices (January 2022)
- Patient Protection & Affordable Healthcare Act (Health Care Reform)
- Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
- Women's Health & Cancer Rights Act/Masectomy Reconstruction
Leave of Absence
Medical - Allegiance
- Summary Plan Description (eff. 1/1/25)
- 2025 Summary of Benefits and Coverage (Effective 1/1/25) - Basic
- 2025 Summary of Benefits and Coverage (Effective 1/1/25) - Custom
- 2025 Summary of Benefits and Coverage (Effective 1/1/25) - Enhanced
- Marriage Affidavit
- Affidavit of Dependent Eligibility
- Medical Claim Form
