FORMS

Brochures, Enrollment Information & Forms

HCTC Forms & Brochures

HCTC  - (HEALTH COVERAGE TAX CREDIT)

(13441A form required by the IRS/HCTC Program)

completed sample forms available at bottom of this page for 13441-A form

SUMMARY PLAN DESCRIPTIONS FOR HCTC PLANS

Medicare Forms & Brochures

MEDICARE

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

SUMMARY PLAN DESCRIPTIONS FOR HARTFORD MEDICARE PLANS

Brochures, Enrollment Information & Forms

HCTC Forms & Brochures

HCTC  - (HEALTH COVERAGE TAX CREDIT)

(13441A form required by the IRS/HCTC Program)

SUMMARY PLAN DESCRIPTIONS FOR HCTC PLANS

Medicare Forms & Brochures

MEDICARE

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

SUMMARY PLAN DESCRIPTIONS FOR HARTFORD MEDICARE PLANS

Brochures, Enrollment Information & Forms

HCTC Forms & Brochures

HCTC  - (HEALTH COVERAGE TAX CREDIT)

(13441A form required by the IRS/HCTC Program)

SUMMARY PLAN DESCRIPTIONS FOR HCTC PLANS

Medicare Forms & Brochures

MEDICARE

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

SUMMARY PLAN DESCRIPTIONS FOR HARTFORD MEDICARE PLANS

CHANGING COVERAGE OPTIONS
NEW ENROLLMENTS
(QUALIFIED FAMILY MEMBER ENROLLING)

SAMPLE 13441A Enrollment Forms

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