FORMS
MEDICAL
General
E.D.I.S. Overview Flyer, A quick glimpse at the E.D.I.S. leadership team
HRA Basics, Health Reimbursement Arrangements
EDHP Stop Loss Program
New Group Submission Checklist
MEC-MEC Value MEC Plus Enrollment Roster
EDHP Buy Up Enrollment - English, To be used when enrolling in EDHP Stop Loss Program
EDHP Buy Up Enrollment - Spanish
Section 105-HRA & MERP Plans
000_Group Information for E.D.I.S., must be completed along withe Benefit Authorization
Agent Authorization
0B1_HRA-MERP Benefit Authorization, for outlining your benefit and plan design
0C1_HRA-MERP Debit Benefit Authorization, for outlining benefits for your HRA/MERP debit card plan
0D1_ICHRA Benefit Authorization, for outlining your ICHRA defined contribution and plan design.
Employee Enrollment Form
Employee Enrollment Form (Espanol/Spanish)
Claims Funding Options