Benefits

                                                                                                                                  

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Forms available in this website are for informational purposes only and subject to our terms of use and are not a substitute for the advice of an attorney or legal counsel. Legal advice of any nature should be sought from legal counsel in that the forms are provided as samples and model guidelines.

                                                                                                                                                             

ADA (Americans with Disabilities Amendments Act)

Americans with Disabilities Amendments Act of 2008 (ADAAA)

Benefits Forms and Documents

Benefit Plan Waiver

Certificate of Group Health Care Plan Coverage

Compliance - Verification of Notification

Domestic Partner Benefits Coverage Affirmation Form

Employee Benefits Survey

TIME OFF: Leave of Absence Model Checklist

TIME OFF: Time Off Request Form

TIME OFF: Vacation Request Form

TUITION ASSISTANCE: Course Enrollment & Tuition Refund Form

TUITION ASSISTANCE: Payment Request Form

TUITION ASSISTANCE: Approval/Verification of Notification Form

CHIP (Children’s Health Insurance Program)

CHIPRA-HIPAA Special Enrollment Provisions Fact Sheet

CHIPRA-Model Noticeto Employees (DOL)

CHIP Expansion Summary Sheet

CHIP & Medicaid Premium Assistance - Model Notice- UPDATED 01-2010

 

COBRA ( Consolidated Omnibus Budget Reconciliation Act

COBRA - Model Election Notice (DOL)

COBRA - Model General (Initial Rights) Notice-DOL

COBRA final regulations

Employees Guide to COBRA Health Benefits - UPDATED 04-2010

Employers Guide to COBRA Health Benefits - UPDATED 04-2010

COBRA/ARRA (American Recovery and Reinvestment Act)

ARRA General Model Notice - Full Version - UPDATED 03-2010

ARRA Model Notice New Election Period - UPDATED 03-2010

ARRA Model Notice Supplemental Information - UPDATED 03-2010

ARRA Model Notice Extended Election Period - UPDATED 03-2010

ARRA Model Alternative Notice - UPDATED 03-2010

ARRA Instructions Review-Denial of COBRA Premium Reduction

ARRA FAQ's- Employers and Premium Reduction - UPDATED 04-2010

COBRA Premium Assitance Irs- Answers for Employers

Form 941-Employer's Payroll Tax - UPDATED 04-2010

Form 941-Instructions Employer's Payroll Tax - UPDATED 04-2010

COBRA/PA State Mini-COBRA

Mini-COBRA - PA Insurance Dept

Mini-COBRA FAQ's

FMLA (Family Medical Leave Act) & Military Leave

FMLA & Military Leave Summary of Final Rule

FMLA Certification-Serious Injury or Illness of Covered Service member

FMLA Certification-Health Care Provider for Employee's Serious Health Condition

FMLA Certification-Health Care Provider for Family Member's Serious Health Condition

FMLA Certification of Qualifying Exigency for Military Family Leave

FMLA Designation Notice

FMLA DOL's Final Rule of Family and Medical Leave Fact Sheet

FMLA Notice of Eligibility, Rights and Responsibilities

FMLA Workplace Poster

GINA (Genetic Information Nondiscrimination Act

EEOC - “Equal Employment Opportunity is the Law” poster - UPDATED 11-2009

Genetic Information Nondiscrimination Act of 2008 - Summary

Genetic Information Nondiscrimination Act of 2008 - Fact Sheet

HIPAA (Health Insurance Portability and Accountability Act)

HIPAA and Wellness Programs

HIPAA Authorization to Disclose

HIPAA Compliance- Information Privacy

HIPAA Health Authorization Policy

HIPAA Privacy Notification

HSA (Health Savings Account)

HSA Tax Form 8889

HSA Tax Form 8889 Instructions

IRS pub969-Health Savings Accounts & Other Tax Favored Health Plans

Medicare & Medicade

CMS Guidance - Creditable Coverage Disclosure to CMS

CMS Guidance - Disclosure form instructions

CMS Guidance - Creditable Coverage to Medicare Part D Eligible Individuals

CMS Guidance - Data Match Instructions

CMS Model Notice - Creditable Coverage - 2009

CMS Model Notice - Non-Creditable Coverage - 2009

Medicare Part D for Plan Sponsors

MSP - Reporting Obligations for Worker's Compensation Plans

MMSEA Section 111 -Liability Insurance, No-Fault Insurance& Workers’ Compensation

MMSEA Section 111 -Registration Process for Responsible Reporting Entities

MMSEA Section 111 -Registration Quick Reference Guide

MMSEA Section 111 -Implementation Timeline

Michelle's Law

Mental Health Parity and Addiction Equity Act Summary Michelle's Law

 

 

 

 

 


 

 


 

 

 





 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 

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