Forms

Forms for health, retirement, and international benefits.

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Health Benefits

Address Change

Employee Enrollment

Employer Certification

End Coverage for an Employee

HSA Adoption Agreement

HSA Contribution Change

Health Plan Bank Authorization

New Employer Checklist

Qualifying Event Change (Marriage, Birth, Adoption, Etc.)

Form 1095 will no longer be mailed to health plan members. This form is for informational purposes only and does not need to be filed with personal income taxes. To request this form, please call (800) 700–2651 or email [email protected]. It will be distributed electronically within 30 days of your request. If you would like to request a copy by mail, please send your request to One Alliance Place, Reynoldsburg, OH 43068.