LivingWell CDHP

Medical Benefit Booklet

RX SPD

2019 Integrated HRA SPD

LivingWell PPO

Medical Benefit Booklet

RX SPD

LivingWell Basic CDHP

Medical Benefit Booklet

RX SPD

LivingWell Limited High Deductible Plan

Medical Benefit Booklet

RX SPD

Waiver

2019 Waiver Dental Vision ONLY HRA SPD

2019 Waiver General Purpose HRA SPD

Flexible Spending Account

2019 Dependent Care FSA SPD

2019 Healthcare FSA SPD

Member-Friendly ACA Preventive Services List

ACA Preventive Services List

2019 Advanced Control Formulary

2019 Advanced Control Specialty Formulary

2019 Preventive Therapy Drug Benefit List

2019 Value Formulary

2019 Value Formulary Quick Reference List

Vitals SmartShopper Reward Service List

Dependent Eligibility Chart

Health Insurance Monthly Premiums

Checklist for New Employees

2019 KEHP Employee Health Insurance Enrollment-Change Application

2019 KEHP FSA Enrollment-Change Application

2019 Retiree Health Insurance Application

2019 ADA Active Application

2019 Life Insurance Application

2019 Dental Insurance Enrollment/Change Form

2019 Vision Insurance Enrollment/Change Form

2019 KEHP Federal Post Tax Request Form

Exception Form

Credit Request 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

WageWorks Dependent Care Reimbursement Form

WageWorks Health Reimbursement Form

Go365 Personal Physician voucher

2019 COBRA Dental Vision Notice

2019 COBRA Health Notice

2019 Kentucky Marketplace Notice Parts A and B

2019 Kentucky Marketplace Notice Part A Only

2019 Legal Notice

2019 Medicare Prescription Drug Creditable Coverage Notice

2019 Notice of Privacy Practices

2019 Terms and Conditions

2019 Tobacco Use Declaration

2019 USERRA Notice on Health Insurance Rights

2019 WHCRA Notice

2019 Wellness Program Notice

2019 CHIP Notice

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

Advanced Control Formulary

Preventive Therapy Drug Benefit

Preventive Therapy Drug Benefit List

ACA Preventive Services List

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

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