Regulatory Forms
Click on subject matter to see listing of forms.
COBRA (Consolidated Omnibus Budge Retirement Act)
HIPAA (Health Insurance Portability Accountability Act)
Gramm Leach Bliley Privacy Act (Privacy Notice)
Women's Health and Cancer Rights Act
StateGuaranty Notices
State Variations

COBRA
 
GNW-GL2006 – COBRA Compliance Guide Sample COBRA Forms and instructions.
General Notice of COBRA Continuation Coverage Rights
COBRA Continuation Coverage Election Notice
Notice of Unavailability of COBRA Coverage
Notice of Termination of COBRA Coverage

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HIPAA (Health Insurance Portability Accountability Act)

HIPAA Information

-GNW-121802-01 - HIPAA Check Lists to determine compliance
Privacy Check List
Security Check List

-GNW-1082 - HIPAA Briefs 1.02
Privacy Regulations.
Security Regulations.

HIPAA Forms
Authorization for Member Initiated Request for Release of Protected Health Information: Form for employee to authorize release of protected health information to persons he or she designates.

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Gramm Leach Bliley Privacy Act (Privacy Notice)

 
GLHIC Privacy Policy
Privacy Employer Letter
Privacy Employee Letter

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Women's Health and Cancer Rights Act

 
WHCRA Notice of Special Rights following Mastectomy.
WHCRA "Employer Instructions" about distributing annual WHCRA notices.

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State Guaranty Notices

 

AK - Alaska

Alaska Guarantee Notice

AR - Arkansas

Arkansas Guarantee Notice

CA - California

California Guarantee Notice

CO - Colorado

Colorado Guarantee Notice

DC - District of Columbia

District of Columbia Guarantee Notice

HI - Hawaii

Hawaii Guarantee Notice

IL - Illinois

Illinois Guarantee Notice

KS - Kansas

Kansas Guarantee Notice

LA - Louisiana

Louisiana Guarantee Notice

MD - Maryland

Maryland Guarantee Notice

MN - Minnesota

Minnesota Guarantee Notice

MO - Missouri

Missouri Guarantee Notice

MS - Mississippi

Mississippi Guarantee Notice

MT - Montana

Montana Guarantee Notice

NV - Nevada

Nevada Guarantee Notice

NH - New Hampshire

New Hampshire Guarantee Notice

NJ - New Jersey

New Jersey Guarantee Notice

NC - North Carolina

North Carolina Guarantee Notice

ND - North Dakota

North Dakota Guarantee Notice

OH - Ohio

Ohio Guarantee Notice

OK - Oklahoma

Oklahoma Guarantee Notice

RI - Rhode Island

Rhode Island Guarantee Notice

SD - South Dakota

South Dakota Guarantee Notice

TX - Texas

Texas Guarantee Notice

UT - Utah

Utah Guarantee Notice

WV - West Virginia

West Virginia Guarantee Notice

WY - Wyoming

Wyoming Guarantee Notice

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State Variations
 

CA - California

CAL COBRA Continuation for Medical/Dental
CA Notice of Continuation Rights for firms with 2-19 lives
CA Notice of Continuation Rights for firms with 20 or more lives.

NJ - New Jersey

NJ Mandatory Notice: Employee insurance rights under Family Leave Act (50 or more lives).

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