Forms/Docs

Health Care

• Health Care FSA Claim Form

Commuter Benefits

• Commuter Spending Account Never Received Pass Claim Form
• Commuter Spending Account Transit Pass Return Form

Dependent Care

• Dependent Care FSA Claim Form

• Adoption Assistance Request for Reimbursement
• Sir Vincent Meredith Application Fund

• Request for Maternity Leave
• Request for Parental Leave

Eligibility

• Domestic Partner Certification

Medical & HSA

• COBRA Continuation of Rights
• Creditable Coverage Notice
• Employee Rights & Responsibilities
• Health Plan Notice of Nondiscrimination
• HIPAA Notice of Privacy Practices
• Marketplace Health Insurance Coverage Options Notice
• Notice of Special Enrollment Rights
• Medicaid and the Children’s Health Insurance Program (CHIP)

• Summary of Benefits and Coverage: Consumer Choice Plan BCBS 2021
• Summary of Benefits and Coverage: Consumer Choice Plan BCBS 2020
• Summary of Benefits and Coverage: Consumer Choice Plan UHC 2021
• Summary of Benefits and Coverage: Consumer Choice Plan UHC 2020
• Women’s Health and Cancer Act of 1998

• 2020 Life and Accident Legal Notices

401(k) Savings Plan

• 401(k) Savings Plan Update (June 2020)
• 401(k) Annual Fee Disclosure
• Safe Harbor Notice of Plan Provisions
• Summary Annual Report
• Qualified Default Investment Alternative Notice
• 401(k) Plan Automatic Enrollment Notice

BMO U.S. Pension Plan

• Annual Funding Notice (2020)
• Annual Return/Report of Employee Benefit Plan
• Single-Employer Defined Benefit Plan Actuarial Information