Forms and Documents

Small Business Enrollment Forms

Your state: Washington CEHIT

Administrative Tools

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, 241 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, 203 KB)
Employee - Change of Coverage Application (PDF, 306 KB)
Employer - Application (PDF, 142KB)
Group Medical Questionnaire (1 page)
Supplemental Dependent Enrollment/Change Form (PDF, 591 KB)

Aetna HealthFund HSA with HealthEquity
For new HSA-Compatible business only starting with 10/1/08 effective dates.

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

Aetna HealthFund HSA Forms - For business prior to 10/1/08

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)

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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