Forms
Flex Forms
The following forms are for flex plans.
Premium Conversion Plan Salary Redirection FormQuestion 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 FormRequired Notice Form
Additional Florida Enrollment Form
New Employee Form
Spouse Eligibility Form
Child Eligibility Form
COBRA/HIPAA Forms
The following employer forms are used if we perform COBRA/HIPAA services for the employer.
Qualifying Event FormHIPAA Certificate Form
Medical Forms
The following forms are used for medical plans.
Claim FormDisability Claim Form
Medical History Form
Release Form