Documents & Forms

Keenan provides you with online access to the forms you need to manage your Workers’ Comp and Benefits programs.

Health Care

Schools & Colleges | Public Agencies
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PRIME Rx Introductory Letter PDF
PRIME Rx Temporary Prescription Services ID PDF
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Briefing – Division of Workers’ Compensation Amends MPN and Employee Information Regulations PDF Published 9/10
Compliance Kit Order Form Word Revised 8/18
New Hire Pamphlet PDF PDF Revised 7/16
Notice of Personal Chiropractor or Personal Acupuncturist Form Word Word
Notice of Potential Eligibility/DWC-1 Claim Form PDF Revised 1/1/16
Personal Physician Request and Acknowledgement Form Word Word Revised 3/14
Posting Notice PDF PDF Revised 1/1/16
WC Benefits Summary PDF Revised 7/18
Workers’ Compensation Update: Important Changes to Predesgnation Regulations Effective 2014 PDF Revised 2014
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Briefing – Implementation of New MPNs effective 1/1/15 PDF Published 12/14
PRIME Advantage MPN – Complete Written Employee Notification PDF PDF Updated 2/16
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COBRA Administration Manual PDF Updated 2018
HIPAA Resource Guide PDF
Medicare Payer Data Collection Form Word
Medicare Secondary Payer Requirements Zip Updated 6/09
MetLife Healthcare Life/AD&D Admin Guide PDF updated 3/15/13
MetLife Premium Statement Zip
Out-of-Network Providers Brochure PDF
Prudential Voluntary AD&D This guide is being updated. Please contact your Keenan Service Representative for assistance.
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