Forms/Document Library

The following forms are here for your convenience.
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• Group Health Insurance - Request for Proposal
• AL&H Group Application or Waiver Form

• Enrollment Change Form
• AL&H Group Application or Waiver Form
• Declaration of Domestic Partners Form
• Authorization to Release Confidential Information
• AL&H Accident Questionnaire
• AL&H Claim Form
• AL&H Debit Authorization Form
• Change of Address

COBRA - Is it applicable?

• Is COBRA required?
• COBRA ASA

Tools to help you understand our forms and documents

• Understanding your EOB (Explanation of Benefit)
• Understanding your ID card

• AL&H LARGE Group Short Application
• Large Group Disclosure Statement

• HealthEquity HSA Authorization Form

• Funds Transmittal
• Secure Site Login Instructions

Privacy Forms

• Allegiance Notice of Privacy Practices