VIP Cosmetic
 

Website Access For Plan Administrators

 

View Monthly Bills and Reports On-Line
View Plan Documents and Amendments On-Line
Add/Terminate Employees and Initiate Coverage Modifications

 

Forms Available For Download

 

COBRA Administration





EXHIBIT 1 - Continuation Coverage Rights Under COBRA - General Notice

EXHIBIT 2 - Notice by Employer to Self Insured Plans of COBRA Qualifying Event

EXHIBIT 3 - Notice by Covered Employee/Qualified Beneficiary to Employer of COBRA Qualifying Event (e.g. Divorce, Medicare Entitlement, Death, Disability, Dependent no Longer Qualifying Under the Plan for Coverage)

EXHIBIT 4 - COBRA Qualifying Event Letter with Election Form for Employer to Provide to Qualified Beneficiary

EXHIBIT 5 - Notice of Unavailability of Continuation Coverage Letter for Employer to Provide to Former Employee

 

Eligibility/Enrollment

 

Enrollment/Change Form
Flexible Spending Account Enrollment Form
Hawaii Clients Enrollment Form
ValueMax Participants Form

 

Health Care Claim Forms

 

Dental Claim Form
Flexibility Spending Account Withdrawl Request
HRA Debit Card Claim Form
Medical Claim Form
PHF Claim Form
RESTAT Prescription Drug Manual Claim Form
Short Term Disability Claim Form
Vision Care Claim Form

 

Protected Health Information (PHI) Release Information

 

PHI Release Form

 
 


Click here if you need to download Adobe Acrobat Reader

 
 

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1016 Collier Center Way, Suite 200 • Naples, Florida 34110
Ph 239/403-7884
Fax: 239/403-7875

Secure Fax Line for Clients of SIP: 239/403-9028