Keenan Schools and Colleges Documents and Forms

Documents & Forms

Schools & Colleges

APPLE Account Authorization for Direct Deposit
APPLE Beneficiary Designation and Change Form
Updated 4/15
APPLE Request for Refund of Contribution Form
APPLE Request for Settlement of Account – RSA
Updated: 11/10/15
APPLE Request Form
APPLE Rollover Contribution Request Form
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
Notice to Employees
Revised 8/18
Personal Physician Request and Acknowledgement Form
Revised 3/14
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
PRIME Plus MPN – Complete Written Employee Notification
Updated 2/16
Benefit Eligibility Contributions Form
Blue Shield – Life
Updated 8/14
COBRA Administration Manual
Updated 2018
Hartford Disability Admin Guide
Updated 10/20/2016
Hartford Life Administration Guide
Health Plan’s Authorization Form
HIPAA Resource Guide
Updated for 2010
MES Administrative Guide
Updated 9/14/09
MetLife Admin Guide – BenefitBridge Addendum
MetLife Schools Basic Life/AD&D Admin Guide
MetLife Schools Voluntary AD&D Admin Guide
MetLife Schools Voluntary Life Admin Guide
Auto Accident Pamphlet
Claims Reporting After Hours Procedure
Claims Reporting Procedures
HSB Claim Filing Guide
HSB Claim Form
Property Claim Form
Third-Party Liability Claim Form