LivingWell CDHP

Medical Benefit Booklet

RX SPD

Integrated HRA SPD

LivingWell PPO

Medical Benefit Booklet

RX SPD

Standard PPO

Medical Benefit Booklet

RX SPD

Standard CDHP

Medical Benefit Booklet

RX SPD

Integrated HRA SPD

Waiver

Waiver Dental Vision ONLY HRA SPD

Waiver General Purpose HRA SPD

Flexible Spending Account

Dependent Care FSA SPD

Healthcare FSA SPD

90-day retail pharmacies

ACA Preventive Drug List

Preventive Therapy Drug Benefit Listing for CDHPs

Preferred Drug List-As of April 2017

Preferred Drug List-As of July 2017

Specialty Drug List-As of April 2017

Specialty Drug List-As of July 2017

Vitals SmartShopper Reward Service List

Dependent Eligibility Chart

Biometric screening pamphlet

ACA Health Insurance Enrollment Application

Active Employee Qualifying Event Form

Active Health Insurance Application

Credit Request Form

Enrollment Eligibility Grievance Form

Federal Post Tax Request Form

FSA Enrollment Change Form

HIPAA Authorization for Release of Information

HIPAA Request for Accounting of Disclosure of Protected Health Information

HIPAA Request for Alternate Communications

HIPAA Request to Amend or Correct Protected Health Information

HIPAA Request to Inspect or Copy Protected Health Information

HIPAA Request for Restrictions on Use or Disclosure of Protected Health Information

LivingWell Promise Grievance Form

Medicaid Eligibility Termination Form

Retiree Enrollment Application

Retiree Qualifying Event Form

Retro Cap Override Form

Tobacco Cessation Voucher Form

Tobacco Use Change Form

Tobacco Use Declaration Form

Update Form

WageWorks Dependent Care Reimbursement Form

WageWorks Health Reimbursement Form

Go365 Personal Physician voucher

Go365 Kroger Company Family of Pharmcies voucher

Go365 Kroger little clinic voucher

Go365 Walgreens voucher

ACA Health Insurance Enrollment Application

Active Health Insurance Application

FSA Enrollment Change Form

KEHP Health Insurance Add-Drop Form

KEHP Update Form

Children’s Health Insurance Program

COBRA Notice

HIPAA Privacy Notice

Kentucky Marketplace Notice Part A Only

Kentucky Marketplace Notice Part A and B

Medicare Prescription Drug Creditable Coverage Notice

Legal Notices for Plan Year 2017

Terms and Conditions for Plan Year 2017

Tobacco Use Declaration

USERRA Notice on Health Insurance Rights

Wellness Program Notice

WHCRA Notice