FORMS

MEDICAL

General

E.D.I.S. Overview Flyer, A quick glimpse at the E.D.I.S. leadership team

Common HRA Member Questions

HRA Basics, Health Reimbursement Arrangements

Why It Works Flyer

Tri-Fold Overview Flyer

EDHP Stop Loss Program

EDHP Overview Flyer

What is an EDHP?

EDHP Employer Application

New Group Submission Checklist

MEC-MEC Value MEC Plus Enrollment Roster

EDHP MVP Enrollment - English

EDHP MVP Enrollment - Spanish

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

FREEDOM Dental Plans

Employer Application

Freedom Enrollment-English

Freedom Enrollment-Spanish