EXHIBIT 1 - Continuation Coverage Rights Under COBRA - Updated General Notice

EXHIBIT 1 - Continuation Coverage Rights Under COBRA - General Notice in Spanish

EXHIBIT 1A - Continuation Coverage Rights Under COBRA - Abbreviated 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 - Alternative Notice For Continuation Coverage Under a State Law [Insurance issuers that provide group health insurance coverage must send the Alternative Notice to persons who became eligible for continuation coverage under a State law. Continuation coverage requirements vary among States, and issuers should modify this model notice as necessary to conform it to the applicable State law. Issuers may also find the model Alternative Notice or the abbreviated model General Notice appropriate for use in certain situations.]

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

EXHIBIT 6 - Model Notice In Connection with Extended Election Periods

EXHIBIT 7 - Premium Assistance Extension Notice

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

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

PHI Release Form