Forms and Documents

Small Business Enrollment Forms

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Your state: New Jersey - North

Administrative Tools

American Recovery and Reinvestment Act of 2009 (ARRA)

Employer Attestation ARRA state continuation employee subsidy

(1 page)

Enrollment Forms

Employer - Dental Verification Form (1 page)
Employer - Application (Dental/Life/Disability) (5 pages)
Employer - Application (4 pages)
Employer - Verification Form (2 pages)
Employer - Participation and Joinder Agreement (1 page)
Employer - NJ Funding Attestation Form (1 page)
HINT Supplemental Enrollment Form (2 pages)
HINT Supplemental Enrollment Form - Spanish (2 pages)
Employee Enrollment/Change Form (4 pages)
Important Health Care Reform Information Notice (PDF, 33 KB) (Must use with Employee Enrollment /Change Form to notify employees of certain changes required by Health Care Reform)
Employee Enrollment/Change Form (Spanish) (4 pages)
Employee - Proof of Eligibility (1 page)
Employee - Waiver of Coverage (1 page)
Employee - Enrollment Form (Dental/Life/Disability) (3 pages)
Employee - Individual Health Questionnaire (1 page)
Employee - 2011 Medicare Group Enrollment for (HMO/PPO) (PDF, 307 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 (4 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)

Tools for Small Businesses

Legal Notices

Health benefits and health insurance plans contain exclusions and limitations. See plan documents for a complete description of coverage.

Health Care Reform

Health Care Reform

Get answers about health reform and learn how changes may affect businesses.

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