Managed Benefits, Inc. offers the latest employee and HR forms in easy to download versions. Click on any form below to open, save or print. 

Health Care Reform – PPACA

 1094 B ACA Form (50 KB)

 1094 C ACA Form (131 KB)

 1095 B ACA Form (291 KB)

 1095 C ACA Form (0 KB)

 7 Reasons Why ‘Pay’ is Not the Easy Answer (41 KB)

 Healthcare Reform Requirements and Applicability (950 KB)

 Healthcare Reform Timeline 2014 and Beyond (588 KB)

 Self-Funded Plans (606 KB)

 The Play-or-Pay Penalty and Counting Employees Under PPACA (614 KB)

 What Employers Need to Know Right Now about Health Care Reform – Fees (588 KB)

COBRA Forms

 COBRA Conversion to Individual Coverage (30 KB)

 Model COBRA Continuation Coverage Election (60 KB)

 Model General Notice of COBRA Continuation Coverage Rights (48 KB)

 Rate Change Notification (30 KB)

 Short Payment Notification Short Payment Notification (14 KB)

I-9 Forms

 Guidance for Completing Form I-9 (565 KB)

 I-9 Employment Eligibility Verification (73 KB)

HIPAA Forms

 Chip Model Notice (80 KB)

 Notice of Declining Enrollment (76 KB)

 Notice of Enrollment Rights (64 KB)

 Notice of Special Enrollment (75 KB)

FMLA Forms

 Certification for Serious Injury or Illness of a Current Servicemember – for Military Family Leave (173 KB)

 Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave (190 KB)

 Certification of Health Care Provider for Employee’s Serious Health Condition (204 KB)

 Certification of Health Care Provider for Family Member’s Serious Health Condition (186 KB)

 Certification of Qualifying Exigency for Military Family Leave (145 KB)

 Designation Notice (124 KB)

Medicare Forms

 Medicare Creditable Coverage Notice (47 KB)

 Medicare Noncreditable Coverage Notice (52 KB)

Women’s Health and Cancer Rights Act

 WHCRA Annual Notice (26 KB)

 WHCRA Enrollment Notice (28 KB)