​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​ Home > Health Insurance > Open Enrollment​ > Open 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 Retiree Enrollment Change Form​​​​​​​​
2027 Summer Transfer Form
Medicaid Eligib​ility Termination Form​​​ ​​
Tobacco Use Cha​nge Form​​​

Documents

​​​2027 Benefits Selection Guid​e
2027 Benefit Selection Guide Digital Magazine​​​​
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

​​​​​​​2027 LivingWell CDHP SBC
2027 LivingWell PPO SBC​
​2027 LivingWell Basic CDHP ​SBC
2027 LivingWell HDHP SBC​​​​​​

​Español​

​2027 Formulario de Inscripció​n/Cambio en Beneficios para Empleados
​​MetLife Formulario de Inscripció​n/Cambio de Seguro de Vida para Empleados​​
​​​​