Resources provided as a service by the HRH Northern New England MSBA Insurance Program support team.
| Medical Insurance Forms |
Description |
| 2008 Comparison Grid |
Comparison grid for 2008 medical plans |
| 2008 Blue Choice $500 |
Blue Choice $500 deductible benefits overview |
| 2008 Blue Choice $1,000 |
Blue Choice $1,000 deductible overview |
| 2008 Blue Choice $2,500 |
Blue Choice $2,500 deductible overview |
| 2008 Blue Choice Preventative Care Rider |
Blue Choice Preventative Care Rider for BC$500/BC$2500 Plan |
| Enrollment/Change form |
Medical insurance enrollment or change form |
| 2008 HSA $3,000 |
HSA $3,000 80/60 Benefit Overview |
| 2008 HSA $3,000 |
HSA $3,000 100/80 Benefit Overview |
| 2008 HSA $5,000 |
HSA $5,000 100/80 Benefit Overview |
| 2008 HMO Maine |
HMO Maine Benefit Overview |
| 2008 HMO Choice |
HMO Choice Benefit Overview |
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| Dental Insurance Forms |
Description |
| 2008 Dental comparison grid |
Compares dental plan benefits for 2008 |
| 2008 Employee enrollment change form |
Dental insurance enrollment or change form |
| 2008 Employer enrollment change form |
Dental insurance employer/group application form |
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| Miscellaneous Forms |
Description |
| MSBA Participation Eligibility Requirements |
MSBA Participation Eligibility Requirements |
| MSBA New Account Application |
MSBA New Account Application |
| MSBA Participation Agreement |
MSBA Participation Agreement |
| Business Associates Agreement |
Business Associates Agreement |
| HIPAA Notice |
HIPAA Notice |
| Agency Bill of Rights |
Agency Bill of Rights |
