Important Document
Forms 2020
To fill out these forms you will need to download a copy to your computer. You may do this by using one of these two methods.
- Click the link and once the document open, press the download button found within the page.
- Highlight the link and then press the Context Menu key command (Shift + F10), then select “Save Link As”.
Once filled out and saved, please deliver them to Theresa Close.
- APH Enrollment Form
- Health Savings Account Deposit Form
- HSA Authorization Form
- FSA and Dependent Care Enrollment Form
- FSA Election Certificate Form
Humana Documents PDF Version
- OE Kit PDF
- Summary of Benefits and Coverage Plan Type NPOS PDF
- Summary of Benefits and Coverage Plan Type NPOS-HDHP PDF
Humana Documents in MS Word Format
- OE Kit Word Doc
- Summary of Benefits and Coverage Plan Type NPOS Word Doc
- Summary of Benefits and Coverage Plan Type NPOS-HDHP Word Doc