Documents & Forms

PRIME Rx Temporary Prescription Services ID

Briefing – Division of Workers’ Compensation Amends MPN and Employee Information Regulations

Compliance Kit Order Form

New Hire Pamphlet

Notice of Personal Chiropractor or Personal Acupuncturist

Notice of Potential Eligibility/DWC-1 Claim Form

Notice to Employees

Personal Physician Request and Acknowledgement Form

WC Benefits Summary

Workers’ Compensation Update: Important Changes to Predesgnation Regulations Effective 2014

Briefing – Implementation of New MPNs effective 1/1/15

PRIME Advantage MPN – Complete Written Employee Notification

PRIME Plus MPN – Complete Written Employee Notification

Benefit Eligibility Contributions Form

COBRA Administration Manual

Hartford Life Administration Guide

Health Plan’s Authorization Form

HIPAA Resource Guide

Prudential Basic Life/AD&D, Optional Life/AD&D Public Agencies Administrative Guide

Prudential LTD Public Agencies Administrative Guide

Prudential STD Only or STD & LTD Public Agencies Administrative Guide