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

2026 Documents, Forms and Legal Notices ​

Forms 

2026 Employee Benefits Enrollment Change Form
2026 Retiree Enrollment Change Form
2026​ ADA Active Enrollment Form
2026 Dental Insurance Enrollment/Change Form
2026 Vision Insurance Enrollment/Change ​Form
2026 KEHP Federal Post Tax Request Form​​​​
​2026 Open Enrollment Exception 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 Grid​​​
2026 How to Enroll​​​
2026 Premiums​​​​
​​2026 BSG 508 Compliant​
2026 ADA Benefits Grid​​​

​​Legal Notices

​​COBRA Right​s​
Notice of Privacy Practices
KEHP Authorization for Release of Information
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

Pharmacy

Member-Friendly ACA Preventive Services List
ACA Preventive Services List
KEHP Preventive Drug List​
2026 Value Formulary Quick Reference
KEHP Value Formulary Drugs Requiring Prior Authorization – Non Specialty​

​Life Insurance

Life Insurance and ADD Certificate of Coverage​​​
2026 OE Life Plan Summary
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 LivingWell CDHP SBC
2026 LivingWell Basic CDHP SBC
2026 LivingWell PPO SBC
2026 LivingWell ​HDHP SBC
Uniform Glossary​

​Español​

2026 Guía de Selección de Beneficios
2026 ​FORMULARIO DE INSCRIPCIÓNCAMBIO DE BENEFICIOS PARA EMPLEADOS
​​2026 FORMULARIO DE EXCEPCIÓN PARA LA INSCRIPCIÓN ABIERTA
​​Resumen de Bronce Vision
Resumen de Plata Vision
Resumen de Oro Vision
Resumen de Bronce Dental
Resumen de Plata Dental
Resumen de Oro Dental​​​
​​