Forms and Documents

Your state: Maine

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Administrative Tools

• Enrollment form tool 
• Administration Manuals 

American Recovery and Reinvestment Act of 2009 (ARRA)

• Employer Attestation ARRA state continuation employee subsidy  (1 page)

Health Care Reform:

• Addendum to New Business Input Documents  (PDF, 520 KB)  Mandatory Requirement for Health Care Reform - Rebate - The employer must complete the attached to determine any potential rebates entitled under the new medical loss ratio requirements set forth in the Affordable Care Act (ACA).

Enrollment Forms 

• Employer - Dental Verification Form  (1 page)
• Employee Enrollment/Change Form  (PDF, 256 KB)
• Employee Enrollment/Change Form - Spanish  (2 pages)
• Employer - Application  (PDF, 852 KB)
• Employee - 2013 Medicare Group Enrollment for (HMO/PPO)  (PDF, 307 KB)
• Supplemental Dependent Enrollment/Change Form   (PDF, 591 KB)
• Employer - Group Medical Questionnaire   (PDF, 579 KB)
  

Aetna HealthFund HSA with HealthEquity
For new HSA-Compatible business only starting with 6/1/08 effective dates. 

• Visit http://aetna.healthequity.com for enrollment forms.

Aetna HealthFund HSA Forms - For business prior to 6/1/08 

• HSA Small Group Member Enrollment Form  (1 page)
• HSA Beneficiary Form  (2 pages)
• HSA AutoDebit Information  (4 pages)
• HSA EFT form  (1 page)
• Employer HSA Contribution Form - PDF version  (3 pages)
• Employer HSA Contribution Form - Excel version 
• HSA Rollover Form  (1 page)
• HSA Deposit Slips  (1 page)

 Aetna HealthFund HRA Materials 

• Aetna HealthFund HRA Enrollment Materials and Ongoing Administration

Cafeteria Plans Enrollment Forms 

• Employer Request for Participation  (1 page)