Forms and Notices

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Enrollment and Enrollment Changes
Medical Claim Forms
Dental Claim Forms
Mail-in Order Form for Prescriptions

Dependent Eligibility for Mercer-Auglaize Plans
Medical Benefits for Work-Related Illness or Injury
Employee Assistance Program
Hepatitis B Immunizations
MRSA Frequently Asked Questions
	Your employer is required by law to provide the following notices at least once each year.
COBRA
Family and Medical Leave Act (FMLA)
Gramm-Leach Privacy Notice
Medicare Part D
Janet's Law (Women's Health & Cancer Rights)