Forms for Employers & Business Partners
J.P. Farley offers many forms for plan participants to utilize in accessing their benefit plan. As an employer, you may occasionally need to work with J.P. Farley to create customized forms for your particular health plan. Members may login to access any such custom forms or obtain a form from your company’s benefits department.
MyBenefits Member Forms:
The following forms and more can be found on the MyBenefits Forms page:
- Accident Detail & Subrogation Form
- Coordination of Benefits Form
- Claim Forms, including Medical, Dental, Disability, Flexible Spending Account Reimbursement Form and Vision Forms
- Enrollment Forms
Many groups choose to create their own custom enrollment forms so these forms are not made available under the general member forms.
- HIPAA Designation of Authorized Representative Request Form (Learn more about Managing Your HIPAA Protected Information)
- Primary Care Physician Request Form
- Uniform Glossary published by the Department of Labor (DOL).
For Our Business Partners:
Business Associate Agreement for Subcontractors – vendors can easily maintain compliance by requesting a copy of J.P. Farley’s Business Associate Agreement (BAA). This Agreement is updated to fulfill the most recent HIPAA privacy and security requirements. Please note: Plan Sponsors, as Covered Entities, have been supplied their required BAA as part of their Administrative Services Agreement with J.P. Farley.
Need a better health plan?
Health benefit plans are changing at a rapid pace – which can be very difficult to follow.
At J.P. Farley, we do the work for you – offering customized group health benefit plans that meet the needs of your employees. Our plans provide everything you need plus the cost savings and flexibility you deserve.