​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​ Home > Health Insurance> Forms and Documents


2026 Documents, Forms and Legal Notices ​

Forms 

2026 Employee Benefits Enrollment Change Form*​​
​​2026 Exception Form​​
2026 Federal Post Tax Request Form*​​​​​​
2026 Summer Transfer Form
Checklist for New Employees​​
Medicaid Eligibility Termination Form*​​​ ​​
Tobacco Use Change Form​​​

Documents

2026 Benefit Selection Guide Digital Magazine​
​​​2026 Benefits Selection Guid​e*​​
2026​​​ Benefits Gri​d*​​​​
2026 How to Enroll​​​
2026 Premiums*​​​​

​​Legal Notices

​​COBRA Right​s​
Notice of Privacy Practices
KEHP Authorization for Release of I​nformation​​
KEHP Request for Accounting of Disclosures
KEHP Request for Alternate Communications
KEHP Request for Restrictions
KEHP Request to Amend PHI
KEHP Request to Inspect or Copy PHI
2026​ Legal Notices*
​​2026​ Terms and Conditions​*​
2026 Tobacco Use Declaration*
2026 Women's Health and Cancer Rights Act Notice​

Pharmacy

Member-Friendly ACA Preventive Services List*
ACA Preventive Services List
KEHP Preventive Drug List*​
KEHP Specialty Drugs Requiring Prior Authorization​*​​
KEHP Value Formulary Quick Reference*​
KEHP Value Formulary Drugs Requiring Prior Authorization – Non Specialty​*​

​Life Insurance

Life Insurance and ADD Certificate of Coverage​​​​
2026​​​ MetLife Rates*​​
MetLife Enrollment Change Form
MetLife Portability Application
MetLife Privacy Notice
MetLife Portability v. Conversion Brochure
MetLife Conversion Application​​

Summaries of Benefits and Coverage

2026 LivingWel​l CDHP SBC
2026 LivingWell PPO SBC
2026 LivingWell Basic CDHP SBC​
2026 LivingWell ​HDHP SBC
2026 Uniform Glossary​

Summary Plan Descriptions and Medical Benefit Booklets​

2026 RX SPD LivingWell CDHP
2026 ​RX SPD LivingWell PPO​​​
2026 RX SPD LivingWell Basic CDHP
2026 RX SPD LivingWell HDHP​​
​​2026 Healthcare FSA SPD
​​​2026 Child Adult Daycare FSA SPD​
2026 LivingWell CDHP​*
2026 LivingWell PPO​
2026 LivingWell Basic CDHP​*
​​2026 LivingWell HDHP*​​

​Español​

2026 Guía de Selección de Beneficios*
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