Initial Cobra Notification
KeenanFit Health Risk Assessment
Leave of Absence Change
Event Calendar NEW
Eligibility
Coverage Levels
Enroll Now!
Medical
Dental
Vision
Life Insurance
Accidental Death & Dismemberment
Long Term Disability
Flexible Spending Accounts
Retirement
Voluntary Benefits
PTO & EIR
Employee Resources
Forms &
Documentation
Links
 
Forms and Documents

The documentation is provided is in the Adobe Acrobat™ file format. You will need to have the free reader program installed on your computer to view and print the documentation. If you do not have the reader installed, you can click the button to the right to install it.
 
General Documents
PDF
Employee Benefits Guide
2009 Employee Benefit Rates
Beneficiary Form
Domestic Partner Affidavit
Tuition Reimbursement Application
Tuition Reimbursement Guidelines
Medical , Dental, Vision and Pharmacy Documents
PDF
Medical Plan Document and Amendment
Medical Claim Form / Keenan HealthCare
Behavorial Health Plan Overview
EOC – Dental

Life / Long Term Disability
PDF
Life Insurance Benefit Summary
LTD Benefit Summary


Express Scripts
PDF
2009 Express Scripts National Preferred Formulary
California Providers
FAQs

Retirement Benefits
PDF
AIG Valic Enrollment Form
AIG Valic TSA
Summary Annual Report

PTO
PDF
PTO Cash-Out Form
PTO Cash-Out Guide
Flexible Spending Accounts
PDF
Ceridian
Request for Reimbursement
Dependent Care Spending Account
Request for Reimbursement
Healthcare Spending Account
Health Care FSA Overview
Dependent Care FSA Overview
Health Care Expense Eligibility
FSA Health and Dependent Care Worksheet

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