LivingWell CDHP

Medical Benefit Booklet

RX SPD

2018 Integrated HRA SPD

LivingWell PPO

Medical Benefit Booklet

RX SPD

Standard PPO

Medical Benefit Booklet

RX SPD

Standard CDHP

Medical Benefit Booklet

RX SPD

2018 Integrated HRA SPD

Waiver

2018 Waiver Dental Vision ONLY HRA SPD

2018 Waiver General Purpose HRA SPD

Flexible Spending Account

2018 Dependent Care FSA SPD

2018 Healthcare FSA SPD

Preferred Drug List - As of January 2018

Preventive Therapy Drug Benefit

2018 Preventive Therapy Drug Benefit List

ACA Preventive Services List- Jan 2018

Vitals SmartShopper Reward Service List

Dependent Eligibility Chart

Biometric screening pamphlet

2018 KEHP Active Enrollment Change Application

2018 KEHP Federal Post Tax Request Form

2018 KEHP FSA Enrollment-Change Application

2018 Life Insurance Application

2018 Retiree Health Insurance Application

2018 Retiree Qualifying Event form

2018 Retiree Update Form

Credit Request Form

Enrollment Eligibility Grievance 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

Medicaid Eligibility Termination Form

Retro Cap Override Form

Tobacco Cessation Voucher Form

Tobacco Use Change Form

Tobacco Use Declaration Form

WageWorks Dependent Care Reimbursement Form

WageWorks Health Reimbursement Form

Go365 Personal Physician voucher

Go365 Kroger Company Family of Pharmcies voucher

2018 Legal Notice

2018 Term and Conditions

2018 Children’s Health Insurance Program

2018 COBRA Notice

2018 HIPAA Privacy Notice

2018 Kentucky Marketplace Notice Part A and B

2018 Medicare Prescription Drug Creditable Coverage Notice

2018 Tobacco Use Declaration

2018 USERRA Notice on Health Insurance Rights

2018 Wellness Program Notice

2018 WHCRA Notice             

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 maintenance drug list

90-day retail pharmacies

ACA Preventive Drug List

Preventive Therapy Drug Benefit Listing for CDHPs

Preferred Drug List-As of October 2017

Specialty Drug List-As of October 2017

ACA Health Insurance Enrollment Application

Active Employee Qualifying Event Form

Active Health Insurance Application

Federal Post Tax Request Form

FSA Enrollment Change Form

Retiree Enrollment Application

Retiree Qualifying Event 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