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Information from your health plan about COVID-19 (coronavirus disease)

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Employer documents

  • 2021 Administrative Guide

    A booklet to help employers and HR representatives administer their Security Health Plan coverage

    Download

  • 2021 Commercial Member Handbook

    A quick-start guide for individual and fully-ensured employer plan members to understand their health plan and find the information they need

    Download

  • 2021 Employer Coverage Customer Guide

    A booklet explaining products and perks for employees of a group preparing to enroll in Security Health Plan coverage

    Download

  • 2021 Enrich Overview

    A handout sharing information about the Enrich product offering for Dodge County.

    Download

  • 2021 Large Employer Certificate

    Provides specific coverage details for your policy

    Download

  • 2021 Transitional Employer Certificate

    Provides specific coverage details for your policy

    Download

  • Automatic Premium Payment Plan Common Questions

    A list of common questions and answers for members about setting up an automatic premium payment plan

    Download

  • Autorización para usar y divulgar información médica protegida (HIPAA, por sus siglas en inglés)

    Utilice este formulario para designar a las personas que usted elija para que tengan acceso a su información médica

    Download

  • Broker quoting checklist

    A checklist designed to help brokers organize their quotes

    Download

  • Care My Way @ Work

    A handout for employers with details highlighting Care My Way @ Work

    Download

  • Care My Way© Brochure

    A brochure about our 24-hour Nurse Line and Care My Way© services

    Download

  • Certificado de Empresa de Transición de 2021

    Proporciona detalles de cobertura específicos de su póliza

    Download

  • Certificado de Empresa Mayor de 2021

    Proporciona detalles de cobertura específicos de su póliza

    Download

  • Domestic Partnership Statement/Enrollment Form

    Complete this form to add a domestic partner to your policy

    Download

  • Employee Health Insurance Application - with medical questionnaire

    Employees of new fully insured large employers and new level-funded employers may complete this form to apply for coverage

    Download

  • Employee Health Insurance Application - without medical questionnaire

    Employees of new fully insured small employers and all existing employers may complete this form to apply for coverage

    Download

  • Employee Health Insurance Election

    A document in which employees indicate they are waiving, enrolling in, terminating, or making changes to their health insurance coverage

    Download

  • Employer Automatic Premium Payment Plan

    Information and form for employers about setting up an automatic premium payment plan

    Download

  • Employer Group Access Request-Security Health Online

    Employers should complete this form to get access to Security Health Online

    Download

  • Employer Group Quote Request

    Complete this form if you’d like a quote for your business

    Download

  • Employer Health Insurance Application

    New fully insured large employers and new level-funded employers may complete this form to apply for coverage

    Download

  • Employer Health Plan Change Request

    A form that employers can use to submit a change in demographics, or add domestic partner coverage

    Download

  • General Capabilities Brochure

    Learn about Security’s plans, provider networks and options available for businesses. We have a plan to fit the needs of every employer

    Download

  • General Capabilities Brochure Flipbook

    All the content from the General Capabilities Brochure PDF in a convenient online flipbook format for display purposes

    Download

  • HIPAA Authorization to Use and Disclose Protected Health Information

    Use this form to designate individuals you choose to have access to your health information

    Download

  • Initial Electronic Enrollment Template

    Employers can use this Excel spreadsheet to help organize their enrolled employee’s information

    Download

  • Initial Electronic Enrollments Employer Guide

    A guide to help employers fill out the Initial Electronic Enrollment Template with employee information

    Download

  • Medication Coverage Options

    Learn what drugs are covered with your plan, their cost and network pharmacies

    Download

  • Member Prescription Drug Reimbursement Request

    Complete this form to submit a prescription drug reimbursement claim

    Download

  • My Security Health Plan Employer Portal Reference Guide

    A guide to help you navigate the employer portal

    Download

  • Premium Contribution Attestation

    Complete this form with the percent you pay toward your employees’ premiums

    Download

  • Renewal Questionnaire

    A questionnaire for employers to complete and submit with their renewal paperwork

    Download

  • Solicitud de seguro médico para empleados - con cuestionario médico

    Los empleados de los grandes empleadores nuevos totalmente asegurados y los nuevos empleadores financiados por niveles podrían completar este formulario para solicitar la cobertura

    Download

  • Solicitud de seguro médico para empleados: sin cuestionario médico

    Los empleados de pequeños empleadores nuevos totalmente asegurados y todos los empleadores existentes pueden completar este formulario para solicitar la cobertura

    Download

  • Special Enrollment Rights

    A notice about special enrollment provisions

    Download

  • Subscriber Change Request

    Complete this form if you have a demographic change, plan change or the addition or deletion of a dependent

    Download

  • Wellness Brochure

    Learn about the wellness programs we offer employers to keep employees healthy and productive

    Download