​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​ Home > Health InsuranceOpen Enrollment​Forms and Documents

​2027 Documents, Forms and Legal Notices ​

Forms 

​2027 Checklist for New Employees​​
2027 Employee Benefits Enrollment Change Form
2027​ ​Federal Post Tax​ Request Form​​
2027 Open Enrollment Exception Form​​​​
2027 Summer Transfer Form
Medicaid Eligib​ility Termination Form​​​ ​​
Tobacco Use Cha​nge Form​​​

Documents

​​​2027 Benefits Selection Guid​e​​
2027​​​ Benefits Gri​d​​​​
2027 Pre​miums​​

​​Legal Notices

​​2027 Legal Notices
​​2027​ Terms and Conditions​
2027 Tobacco Use Declaration
COBRA Right​s​
KEHP Authorization for Release of I​nformation​​
KEHP Request for Accounting o​​​​f Disclosures​
KEHP Request for Al​ternate Communications​
KEHP Request for Restrictions
KEHP Request to Amend PHI
KEHP Request to Inspect or Copy PHI
Notice of Privacy Practices

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​​​​
Life Insurance Plan Summary​​​​​
MetLife Enrollment Change Form​​​​
2027 MetLife Rates

​Summaries of Benefits and Coverage


Summary Plan Descriptions and Medical Benefit Booklets​


​Español​


​​​​​

​​
​​​​






​​​