Keenan Health Care Documents and Forms

Documents & Forms

Health Care

PRIME Rx Introductory Letter
PRIME Rx Temporary Prescription Services ID
Briefing – Division of Workers’ Compensation Amends MPN and Employee Information Regulations
Published 9/10
Compliance Kit Order Form
Revised 8/18
New Hire Pamphlet
Revised 7/16
Notice of Personal Chiropractor or Personal Acupuncturist
Notice of Potential Eligibility/DWC-1 Claim Form
Revised 1/1/16
Personal Physician Request and Acknowledgement Form
Revised 3/14
Posting Notice
Revised 1/16
WC Benefits Summary
Revised 7/18
Workers’ Compensation Update: Important Changes to Predesgnation Regulations Effective 2014
Revised 2014
Briefing – Implementation of New MPNs effective 1/1/15
Published 12/14
PRIME Advantage MPN – Complete Written Employee Notification
Updated 2/16
COBRA Administration Manual
Updated 2018
HIPAA Resource Guide
Medicare Payer Data Collection Form
Medicare Secondary Payer Requirements
Updated 6/09
MetLife Healthcare Life/AD&D Admin Guide
MetLife Premium Statement
Out-of-Network Providers Brochure
Prudential Voluntary AD&D
This guide is being updated. Please contact your Keenan Service Representative for assistance.