IMPORTANT NOTES:
- Small Group: Rates and Products for 2024 Dental are pending regulatory approval.
- Medium Group: Products for 2024 Medical, Dental and Vision are pending regulatory approval.
- Large Group: Products for 2024 Medical, Dental and Vision are pending regulatory approval.
| Name | Date published | Plan year | Language |
|---|---|---|---|
| Affidavit of Qualifying Domestic Partnership | 02/07/2018 | All | English |
| Affidavit of Qualifying Incapacitated Dependent (individual) 2024 | 05/16/2023 | All | English |
| Affidavit of Qualifying Incapacitated Dependent (large group) 2024 | 05/01/2023 | All | English |
| Affidavit of Qualifying Incapacitated Dependent (small and mid-size group) | 05/02/2023 | All | English |
| HSA authorization form | 02/12/2018 | All | English |