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Forms & Documents
These Forms and Documents are provided for your use. Please feel free to print and copy them as needed.

Group Health
Employee and Family Medical Questionnaire
Group Census Form
Pre-Quote Questionnaire
Medical Questionnaire
Group Health Waiver Form
Authorization to obtain information

Mini Web information form
 

Basic - Human Resources information website

Basic - COBRA News update

Cobra Tool Kit
Cobra Qualifying Event Packet #1 (Termination)
Cobra Qualifying Event Packet #2 (other reasons)
Cobra Initial Notice
Notice of termination

Cobra Subsidy Economic Stimulus information

New Cobra Notices required by the Economic Stimulus Package

Continuation Coverage Election Notice

Abbreviated Continuation Coverage Election Notice

Extended Election Periods Notice

Individual Health
AEA Verification Form
BBB Verification Form
 

Broker of Record Change for Blue Cross

Privacy Promise





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