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Healthcare - Assistance Plan (HCAP) Documents

HealthCare Assistance Plan (HCAP) Documents

full plan Information

2016 HCAP Plan Document
2015 HCAP Plan Document

SUMMARY PLAN INFORMATION

Enrollment Applications

2017 Employee Healthcare Enrollment Application | LEGACY
2017 Employee Healthcare Enrollment Application | OPTION (DEFAULT TO STANDARD PLAN) | OPTION (DEFAULT TO CURRENT PLAN)
2017 Employee Healthcare Enrollment Application | STANDARD

2016 Employee Healthcare Enrollment Application | LEGACY
2016 Employee Healthcare Enrollment Application | OPTION (DEFAULT TO STANDARD PLAN) | OPTION (DEFAULT TO CURRENT PLAN)
2016 Employee Healthcare Enrollment Application | STANDARD

Decline Coverage Form
Disability Certification Forms

 

Reimbursement & Change Forms

Employee Benefits Change Request Form
Employee Benefits Termination Request Form

 

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 Healthcare Transition for PPO and Member Services in 2015 
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