Forms

	About TLC

	Plan Information

	Comparison of Benefits

	Enrollment

Forms

	Policies and Procedures

	Communications

	Other Benefits

Forms below are in PDF format. The Acrobat Adobe Reader must be on your PC in order for you to view these forms. If you do not have the reader, click to install a free download.

Adoption Agreement
Appeal Form
Certificate of Creditable Health Coverage
Contact Update Form
Creditable Coverage Notice (General) - 2008
Employer Data Sheet for 2010
Enrollment Form for 2009-2010 Plan Year
Enrollment Form for 2010-2011 Plan Year
Extended Coverage Election Notice
Extended Coverage General Notice
Group Application
Individual Address Change Form
Materials Order Form 2010
Materials Order Form for ValueOptions
Medco H1N1 Claims Form
Medco Materials Order Form 2008
Memo of Understanding
Notification of Change Form
USERRA Notice