Documents & Forms
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- Documents & Forms
Documents & Forms | Keenan
Apple
- APPLE Account Authorization for Direct Deposit Adobe PDF
- APPLE Beneficiary Designation and Change Form Adobe PDF
- APPLE Request for Refund of Contribution Form Adobe PDF
- APPLE Request for Settlement of Account RSA Adobe PDF
- APPLE Request Form Microsoft Excel
- APPLE Required Minimum Distribution Request Form Adobe PDF
- APPLE Rollover Contribution Request Form Adobe PDF
- Social Security Form SSA-1945 Adobe PDF
Benefits
- COBRA Administration Manual Adobe PDF, Login Required
- HIPAA Resource Guide Adobe PDF, Login Required
- Health Plans Authorization Form Microsoft Word
MPN
- Briefing Implementation of New MPNs effective 1115 Adobe PDF
- PRIME Advantage MPN Complete Written Employee Notification - English Adobe PDF
- PRIME Advantage MPN Complete Written Employee Notification - Spanish Adobe PDF
- PRIME Plus MPN Complete Written Employee Notification - English Adobe PDF
- PRIME Plus MPN Complete Written Employee Notification - Spanish Adobe PDF
PL Claim Kit
- Auto Accident Pamphlet Adobe PDF
- Claims Reporting After Hours Procedure Adobe PDF
- Claims Reporting Procedures Adobe PDF
- HSB Claim Filing Guide Adobe PDF
- HSB Claim Form Adobe PDF
- Property Claim Form Adobe PDF
- Third-Party Liability Claim Form Adobe PDF
WC Claims Kit
- Compliance Kit Order Form Microsoft Word
- New Hire Pamphlet - English Adobe PDF
- New Hire Pamphlet - Spanish Adobe PDF
- Notice of Personal Chiropractor or Personal Acupuncturist - English Microsoft Word
- Notice of Personal Chiropractor or Personal Acupuncturist - Spanish Microsoft Word
- Notice of Potential EligibilityDWC-1 Claim Form Adobe PDF
- Notice to Employees - English Adobe PDF
- Notice to Employees - Spanish Adobe PDF
- Personal Physician Request and Acknowledgement Form - English Microsoft Word
- Personal Physician Request and Acknowledgement Form - Spanish Microsoft Word
- WC Benefits Summary Adobe PDF
- Workers Compensation Update Important Changes to Predesignation Regulations Effective 2014 Adobe PDF
Workers Comp
- PRIME Rx Temporary Prescription Services ID English Spanish Adobe PDF, Login Required
Documents & Forms | Keenan
Apple
- APPLE Beneficiary Designation and Change Form Adobe PDF
- APPLE Request for Refund of Contribution Form Adobe PDF
- APPLE Request for Settlement of Account RSA Adobe PDF
- APPLE Request Form Microsoft Excel
- APPLE Required Minimum Distribution Request Form Adobe PDF
- APPLE Rollover Contribution Request Form Adobe PDF
- Social Security Form SSA-1945 Adobe PDF
Benefits
- Benefit Eligibility Contributions Form Adobe PDF, Login Required
- COBRA Administration Manual Adobe PDF, Login Required
- HIPAA Resource Guide Adobe PDF, Login Required
- PA_Prudential_STD_Only_or_STD_and_LTD_Public_Agencies_Administrative_Guide Adobe PDF, Login Required
- Prudential STD Only or STD LTD Public Agencies Administrative Guide Adobe PDF, Login Required
- Health Plans Authorization Form Microsoft Word
MPN
- Briefing Implementation of New MPNs effective 1115 Adobe PDF
- PRIME Advantage MPN Complete Written Employee Notification - English Adobe PDF
- PRIME Advantage MPN Complete Written Employee Notification - Spanish Adobe PDF
- PRIME Plus MPN Complete Written Employee Notification - English Adobe PDF
- PRIME Plus MPN Complete Written Employee Notification - Spanish Adobe PDF
WC Claims Kit
- Briefing Division of Workers Compensation Amends MPN and Employee Information Regulations Adobe PDF
- Compliance Kit Order Form Microsoft Word
- New Hire Pamphlet - English Adobe PDF
- New Hire Pamphlet - Spanish Adobe PDF
- Notice of Personal Chiropractor or Personal Acupuncturist - English Microsoft Word
- Notice of Personal Chiropractor or Personal Acupuncturist - Spanish Microsoft Word
- Notice of Potential EligibilityDWC-1 Claim Form Adobe PDF
- Notice to Employees - English Adobe PDF
- Notice to Employees - Spanish Adobe PDF
- Personal Physician Request and Acknowledgement Form - English Microsoft Word
- Personal Physician Request and Acknowledgement Form - Spanish Microsoft Word
- WC Benefits Summary Adobe PDF
- Workers Compensation Update Important Changes to Predesgnation Regulations Effective 2014 Adobe PDF
Workers Comp
- PRIME Rx Temporary Prescription Services ID English Spanish Adobe PDF, Login Required
Documents & Forms | Keenan
Benefits
- COBRA Administration Manual Adobe PDF, Login Required
- HIPAA Resource Guide Adobe PDF, Login Required
- MetLife Healthcare LifeADD Admin Guide Adobe PDF, Login Required
- Medicare Payer Data Collection Form Microsoft Word
- MetLife Premium Statement Microsoft Excel
- Out-of-Network Providers Brochure Adobe PDF
WC Claims Kit
- Briefing Division of Workers Compensation Amends MPN and Employee Information Regulations Adobe PDF
- Compliance Kit Order Form Microsoft Word
- New Hire Pamphlet - English Adobe PDF
- New Hire Pamphlet - Spanish Adobe PDF
- Notice of Personal Chiropractor or Personal Acupuncturist English Microsoft Word
- Notice of Personal Chiropractor or Personal Acupuncturist Spanish Microsoft Word
- Notice of Potential EligibilityDWC-1 Claim Form Adobe PDF
- Personal Physician Request and Acknowledgement Form - English Adobe PDF
- Personal Physician Request and Acknowledgement Form - Spanish Adobe PDF
- Posting Notice - English Adobe PDF
- Posting Notice - Spanish Adobe PDF
- WC Benefits Summary Adobe PDF
- Workers Compensation Update Important Changes to Predesgnation Regulations Effective 2014 Adobe PDF
Workers Comp
- PRIME Rx Temporary Prescription Services ID English Spanish Adobe PDF, Login Required