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Click to Download Forms:

Helpful Links:

• Affordable Care Act - How Does It Affect You?

• Medicare Part D (2011)

• W2 Reporting of Healthcare Costs (2011)

• Michigan Assessment (2012)

• Comparative Effectiveness Research Fee (2012)

• Medical Claim Form

• Family Claim Form

• Subrogation Statement

• Subrogation Statement (Montgomery County)

• Dependent Care Reimbursement

• Incapacitated Dependent Certification Form

• Flexible Spending Reimbursement Form

• PHI Release Authorization Form

• Designation of Authorized Representative

• FSA/HRA Eligible/Ineligible Expenses Fact Sheet

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