top of page

Document with Pen

FORMS

Brochures, Enrollment Information & Forms

HCTC Forms & Brochures

HCTC - (HEALTH COVERAGE TAX CREDIT)

HCTC AIRLINE ENROLLMENT FORM

13441A Form - IRS Enrollment Form

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

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

2021 AIRLINE TRUST HCTC ENROLLMENT BOOK

SUMMARY PLAN DESCRIPTIONS FOR HCTC PLANS

SILVER PLAN SPD

BRONZE PLAN SPD

Medicare Forms & Brochures

MEDICARE

Aetna/BCBSM MEDICARE ENROLLMENT FORM

HARTFORD MEDICARE ENROLLMENT FORM

2021 MEDICARE Enrollment Book

Aetna Formulary

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

SUMMARY PLAN DESCRIPTIONS FOR HARTFORD MEDICARE PLANS

PREMIUM CHOICE PLAN ( PLAN F )

PREMIUM PLAN ( PLAN G w/ COPAY )

SAMPLE 13441A FORMS

SAMPLE for Changing Coverage

SAMPLE for New Enrollment

SAMPLE for Qualified Family Member

Brochures, Enrollment Information & Forms

HCTC Forms & Brochures

HCTC - (HEALTH COVERAGE TAX CREDIT)

HCTC AUTO ENROLLMENT FORM

13441A Form - IRS Enrollment Form

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

2021 AUTO TRUST HCTC ENROLLMENT BOOK

SUMMARY PLAN DESCRIPTIONS FOR HCTC PLANS

SILVER PLAN SPD

BRONZE PLAN SPD

Medicare Forms & Brochures

MEDICARE

Aetna/BCBSM MEDICARE ENROLLMENT FORM

HARTFORD MEDICARE ENROLLMENT FORM

2021 AUTO MEDICARE ENROLLMENT BOOK

Aetna Formulary

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

SUMMARY PLAN DESCRIPTIONS FOR HARTFORD MEDICARE PLANS

PREMIUM CHOICE PLAN ( PLAN F )

PREMIUM PLAN ( PLAN G w/ COPAY )

SAMPLE 13441A FORMS

SAMPLE for Changing Coverage

SAMPLE for New Enrollment

SAMPLE for Qualified Family Member

Brochures, Enrollment Information & Forms

HCTC Forms & Brochures

HCTC - (HEALTH COVERAGE TAX CREDIT)

HCTC STEEL ENROLLMENT FORM

13441A Form - IRS Enrollment Form

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

2021 STEEL TRUST HCTC ENROLLMENT BOOK

SUMMARY PLAN DESCRIPTIONS FOR HCTC PLANS

SILVER PLAN SPD

BRONZE PLAN SPD

SAMPLE 13441A FORMS

SAMPLE for Changing Coverage

SAMPLE for New Enrollment

SAMPLE for Qualified Family Member

Medicare Forms & Brochures

MEDICARE

Aetna/BCBSM MEDICARE ENROLLMENT FORM

HARTFORD MEDICARE ENROLLMENT FORM

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

SUMMARY PLAN DESCRIPTIONS FOR HARTFORD MEDICARE PLANS

PREMIUM CHOICE PLAN ( PLAN F )

PREMIUM PLAN ( PLAN G w/ COPAY )

CHANGING COVERAGE OPTIONS

NEW ENROLLMENTS

(QUALIFIED FAMILY MEMBER ENROLLING)

SAMPLE 13441A Enrollment Forms

SAMPLE 13441A FORMS

SAMPLE for Changing Coverage

SAMPLE for New Enrollment

SAMPLE for Qualified Family Member

have

questions?

Call Us!

OR

(844)HCTC-NOW

(844)428.2669

bottom of page