VIP Cosmetic
SIP Holiday Schedule
 

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 - COBRA Model Notice (non-ARRA) - English Version

EXHIBIT 1a - COBRA Model Notice (non-ARRA) - Spanish Version

EXHIBIT 3 - COBRA Model Supplemental Information Notice
Plans that are subject to continuation coverage provisions under Federal or State law should provide the Supplemental Information Notice to all individuals who elected and maintained continuation coverage based on the following qualifying events:

EXHIBIT 4 - COBRA Model Notice of Extended Election Period
Plans that are subject to continuation coverage provisions under Federal or State law must provide, before the end of the required time period for providing a COBRA election notice, the Notice of Extended Election Period to all individuals who:

EXHIBIT 5 - COBRA Model Updated Alternative Notice
Insurance issuers that offer group health insurance coverage that is subject to comparable continuation coverage requirements imposed by State law must provide the Alternative Notice to all qualified beneficiaries, not just covered employees, who have experienced a qualifying event through 5/31/10.

EXHIBIT 6 - COBRA Premium Reduction Fact Sheet - English Version

EXHIBIT 6 - COBRA Premium Reduction Fact Sheet - Spanish Version

 

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

 
 


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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