Benefits

ADAAA Final Regulations Effective May 2011
Benefit Plan Waiver
Benefits Coverage Domestic Partner Affirmation Form
Breach of Protected Health Information Notice Requirements
Certificate of Group Health Care Plan Coverage
CHIP Expansion Summary Sheet
CHIP Model Notice (Exp 9/30/13)
COBRA Model Initial Rights Notice
COBRA: Model Qualifying Event Election Notice
Connecticut Employment Protections for Victims of Family Violence
Creditable Coverage - CMS Disclosure Guidance
Creditable Coverage - Template Medicare Creditable Coverage Notice
Creditable Coverage - Template Medicare Non-Creditable Coverage Notice
Employee Benefits Survey
Final Rule on Family and Medical Leave Act and Military Leave Summary
Flu- Employee Flu Guidelines
Flu- Employer Flu Pandemic Planning Checklist
FMLA Certification for Serious Injury or Illness of Covered Servicemember for Family Leave
FMLA Certification of Health Care Provider for Employee
FMLA Certification of Health Care Provider for Family Member
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
FSA HSA HRA Eligible Expenses and OTC Drugs
Genetic Information Nondiscrimination Act of 2008 (GINA)
GINA Final Regulations for Employers
Health Care Reform General Employee Memo Template
Health Care Reform Notice for Open Enrollment
Health Care Reform Summary and Timeline
Health Care Reform: Action Plan
Health Care Reform: Appeals Process Requirements
Health Care Reform: Broker Toolkit
Health Care Reform: Dependent to Age 26 Carriers Extending Coverage Early
Health Care Reform: Dependent to Age 26 Coverage DOL Fact Sheet
Health Care Reform: Dependent to Age 26 Coverage Summary
Health Care Reform: Dependent to Age 26 Early Extension Sample Employee Memo Template
Health Care Reform: Dependent to Age 26 IRS Notice 2010-38 Tax Treatment of Health Care Benefits Provided with Respect to Children Under Age 27
Health Care Reform: Dependent to Age 26 Model Open Enrollment Opportunity
Health Care Reform: Early Retiree Reinsurance HHS Fact Sheet
Health Care Reform: Early Retiree Reinsurance Program
Health Care Reform: Early Retiree Reinsurance Program Application FAQs
Health Care Reform: Early Retiree Reinsurance Program Application Instructions
Health Care Reform: Early Retiree Reinsurance Program Application Submission Do's & Don'ts
Health Care Reform: Early Retiree Reinsurance Program OFFICIAL Application
Health Care Reform: FSA/HSA/HRA and OTC Drug Exclusion
Health Care Reform: Grandfathered Health Plans
Health Care Reform: Grandfathered Health Plans Model Disclosure Notice Added August 2nd!
Health Care Reform: Grandfathered Health Plans- What it Means to be a Grandfathered Plan
Health Care Reform: High Risk Pool NJ Protect
Health Care Reform: High Risk Pool PA Fair Care Fact Sheet
Health Care Reform: High Risk Pool PA Fair Care Summary
Health Care Reform: Lactation Accommodation
Health Care Reform: Lactation Accommodation DOL Fact Sheet
Health Care Reform: Lactation Accommodation Sample Policy
Health Care Reform: NJ Small Employer Health Plans Coinsurance and Max Out of Pockt Credit
Health Care Reform: Nondiscrimination Requirements in a Nutshell
Health Care Reform: Nondiscrimination Rules
Health Care Reform: Preventive Services Requirements for Plans Starting After September 23, 2010
Health Care Reform: Preventive Services Requirements HHS Fact Sheet
Health Care Reform: Preventive Services Requirements Summary
Health Care Reform: Small Business Health Care Tax Credit
Health Care Reform: Small Business Health Care Tax Credit Eligibility Worksheet
Health Care Reform: Small Business Health Care Tax Credit IRS Eligibility Worksheet
Health Care Reform: Small Business Health Care Tax Credit IRS Form 8941
Health Care Reform: Small Business Health Care Tax Credit IRS Form 8941 INSTRUCTIONS
Health Care Reform: W-2 for 2011 DRAFT FORM
Health Care Reform: W-2 Reporting Requirements
HIPAA and Wellness Programs
HIPAA Authorization to Disclose
HIPAA Compliance- Information Privacy
HIPAA Health Authorization Policy
HIPAA Privacy Notification
HSA Tax Form 8889
HSA Tax Form 8889 Instructions
Medicare Part D for Plan Sponsors
Medicare Secondary Payer Mandatory Reporting Requirements Registration Guide
Medicare Secondary Payer Mandatory Reporting Requirements User Guide
Medicare Secondary Payer Reporting Obligations
Mental Health Parity and Addiction Equity Act Summary
MERP and HRA Plans: New CMS Reporting Requirement
Michelle's Law
Mini-COBRA & Dependent Coverage Webinar Presentation
New Jersey Continuation Coverage Model Election Notice WITHOUT SUBSIDY INFORMATION
New Jersey Family Insurance Application for Benefits
New Jersey Family Leave Insurance Fact Sheet
New Jersey Family Leave Insurance Workplace Poster
New Jersey: Grace's Law for Hearing Aid Coverage
PA Dependent to Age 30 Dept of Insurance Fact Sheet
PA Dependent to Age 30 Summary
PA Mini COBRA Model Election Notice WITHOUT SUBSIDY INFORMATION
PA Mini-COBRA Administrative Services
PA Mini-COBRA FAQs
PA Mini-COBRA Summary
Philadelphia City Ordinance- Domestic & Sexual Violence Leave
Philadelphia Domestic Violence Leave Poster
Stimulus Bill: Application for Review of ARRA Premium Reduction Denial (2-19 EMPLOYEES ONLY)
Stimulus Bill: Application for Review of ARRA Premium Reduction Denial (20+ EMPLOYEES ONLY)
Stimulus Bill: Application for Review of ARRA Premium Reduction Denial Instructions (20+ EMPLOYEES)
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: Program Approval Form
Verification of Notification

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. LEGAL ADVICE OF ANY NATURE SHOULD BE SOUGHT FROM LEGAL COUNSEL IN THAT THE FORMS ARE PROVIDED AS SAMPLES AND MODEL GUIDELINES.