Previous Years Forms Below Current Years Forms/Booklets
Open Enrollment March 2023
Open Enrollment March 2022
Open Enrollment March 2018-2020
Deductable Plan Change Form 2017
Deductable Plan Change Form 2016
Deductable Plan Change Form 2015
Deductable Plan Change Form 2014
Deductable Plan Change Form 2013
Deductable Plan Change Form 2012
Deductable Plan Change Form 2011
Life Insurance
Health Statement - Evidence of Insurability 2023
Health Statement - Evidence of Insurability ->2022
Medical Plans
Overview PPO Standard and PPO Value Plans 2024
Overview HSA Standard and Value Plans 2024
Summary of Benefits and Coverage 2024
HSA Standard Plan
HSA Value Plan
PPO Standard Plan
PPO Value Plan
Overview PPO Standard and PPO Value Plans 2023
Overview HSA Standard and Value Plans 2023
Summary of Benefits and Coverage 2023
HSA Standard Plan
HSA Value Plan
PPO Standard Plan
PPO Value Plan
Home Delivery Order form 2023
Overview PPO Standard and PPO Value Plans 2022
Overview HSA Standard and Value Plans 2022
Summary of Benefits and Coverage 2022
HSA Standard Plan
HSA Value Plan
PPO Standard Plan
PPO Value Plan
Walk-In Center Locations 2022
New Employee Flexible Benefit (125) enrollment form 2022
Health Benefit Enrollment form 2022
Participant Change form 2022
Home Delivery Order form 2022
Medical Claim form - Anthem 2022
Overview HSA Standard and Value Plans 2020-21
Overview PPO Standard and Value Plans 2020-21
Summary of Benefits and Coverage 2020-21
HSA Standard Plan
HSA Value Plan
PPO Standard Plan
PPO Value Plan
Walk-In Center Locations 2020-21
Health Benefit Enrollment Form 2018-2021
Medical Claim form - Anthem 2020
Overview HSA Standard and Value Plans 2018-19
Overview PPO Standard and Value Plans 2018-19
Summary of Benefits and Coverage 2018-19
HSA Standard Plan
HSA Value Plan
PPO Standard Plan
PPO Value Plan
Summary Plan Description 2017
Medical Plans A-B-C Overviews 2017
Qualified High Deductable Plan D Overview 2017
Summary of Benefits and Coverage 2017
Plan "A" - $1200 deductable
Plan "B" - $1800 deductable
Plan "C" - $3600 deductable
HSA Compatible - Qualified High Deductable Plan D
Walk-In Center Locations 2017
Health Benefit Enrollment Form 2017
Medical Benefit A B C Overviews 2016
Summary of Benefits and Coverage 2016
Maine Auto Dealers SBC Plan A 1200 80-60 PPO
Maine Auto Dealers SBC Plan B 1800 80-60 PPO
Maine Auto Dealers SBC Plan C 3600 80-60 PPO
MADA HSA Compatible - Qualified High Deductable Plan D
Qualified High Deductible Health Plan Overview 2016
Health Benefit Enrollment Form 2013-2016
Medical Benefit Overviews 2015
Summary of Benefits and Coverage 2015
Maine Auto Dealers SBC Plan A 1200 80-60 PPO
Maine Auto Dealers SBC Plan B 1800 80-60 PPO
Maine Auto Dealers SBC Plan C 3600 80-60 PPO
MADA HSA Compatible - Qualified High Deductable Plan D
Qualified High Deductible Health Plan Overview 2015
Pharmacy - mail order participation 2015
Medical Benefit Overviews 2014
Summary of Benefits and Coverage 2014
Maine Auto Dealers SBC Plan A 1200 80-60 PPO
Maine Auto Dealers SBC Plan B 1800 80-60 PPO
Maine Auto Dealers SBC Plan C 3600 80-60 PPO
MADA HSA Compatible - Qualified High Deductable Plan D
Life and AD&D Coverage
Short Term Disability Booklet
Qualified High Deductible Health Plan Overview 2014
Medical Benefit Overviews 2013
Qualified High Deductible Health Plan Overview 2013
Medical Benefit Overviews 2012
Health Benefit Enrollment Form 2012
Medical Benefit Overviews 2011
Health Benefit Enrollment Form 2011
Medical Benefit Overviews 2010
Participating Mail Order Pharmacies
Medical Certificate Booklet 2011
Medical Certificate Booklet 2010
Medical Certificate Booklet 2009
Medical Certificate Booklet 2008
New Employee 125 Enrollment Form -Group Dynamic
Dependent Status Form
Participant Change Form
Optional Life Enrollment Form
Optional Life Health Statement - Evidence of Insurability
Dental Plan
Overview of Benefits 2024
Overview of Benefits 2023
Overview of Benefits 2022
Dental Coverage Outline 2018-2021
Dental Coverage Outline 2017
Dental Coverage Outline 2016
Dental Coverage Outline 2015
Dental Coverage Outline 2014
Dental Coverage Outline 2013
Dental Coverage Outline 2012
Dental Coverage Outline 2011
Dental Coverage Outline 2010
Dental Certificate Booklet 01/01/2010
Dental Certificate Booklet 03/01/2008
Dental Claim form - Anthem ->2022
Vision Plan
Vision Overview of Benefits 2024
Vision Overview of Benefits 2023
Vision Overview of Benefits 2022
Vision Overview of Benefits 2018-2020
Provider Directory ->2022
COBRA
Notice of Group Insurance Conversion form (COBRA) 2024
Notice of Group Insurance Conversion form (COBRA) 2023
Notice of Group Insurance Conversion form (COBRA) 2022
Notice of Group Insurance Conversion form (COBRA) 2018-2021
Notice of Group Insurance Conversion form (COBRA) 2015-2017
Notice of Group Insurance Conversion Privileges 2010-2014
Disability Management Forms
Employee Statement
Group Disability Insurance Authorization
Employer Statement
Attending Physician Statement