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Model Notices
CAA
No Surprises Act Model Notice
COBRA
Initial COBRA Notice
Initial COBRA Notice (Spanish)
COBRA Election Notice
COBRA Election Notice (Spanish)
ERISA
ERISA Rights Statement
ERISA Summary Annual Report
FMLA
FMLA General Notice (in English)
FMLA General Notice (in Spanish)
Eligibility & Rights and Responsibilities Notice
Designation Notice
Certification of Health Care Provider for Employee’s Serious Health Condition (PDF)
Certification of Health Care Provider for Family Member’s Serious Health Condition (PDF)
Certification of Qualifying Exigency For Military Family Leave (PDF)
Certification for Serious Injury or Illness of Covered Servicemember -- for Military Family Leave (PDF)
Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave (PDF)
ACA
Grandfathered Plan Model Notice
Grandfathered Plan Model Notice (Spanish)
Exchange Notice: Employers With a Group Health Plan
Exchange Notice: Employers With a Group Health Plan (Spanish)
Exchange Notice: Employers Without a Group Health Plan
Exchange Notice: Employers Without a Group Health Plan (Spanish)
Lifetime Limits Model Notice
Lifetime Limits Model Notice (Spanish)
Notice of Adverse Benefit Determination
Notice of Final Internal Adverse Benefit Determination
Notice of Final External Adverse Benefit Determination
Notice of Final External Adverse Benefit Determination (Spanish)
Notice of Nondiscrimination Under 1557
Patient Protections Model Notice
Patient Protections Model Notice (Spanish)
Summary of Benefits and Coverage (SBC)
Uniform Glossary of Coverage and Medical Terms
HIPAA
Employer CHIP Notice
Employer CHIP Notice (Spanish)
Notice of Privacy Practices Booklet (in English)
Notice of Privacy Practices Full Page (in English)
Notice of Privacy Practices Layered (in English)
Notice of Privacy Practices Text-only (in English)
Notice of Privacy Practices Booklet (in Spanish)
Notice of Privacy Practices Full Page (in Spanish)
Notice of Privacy Practices Layered (in Spanish)
Notice of Privacy Practices Text-only (in Spanish)
Notice of Special Enrollment Rights
Medicare
Part D Creditable Coverage Notice to Eligible Individuals
Part D Non-Creditable Coverage Notice to Eligible Individuals
Model Creditable Coverage Disclosure Notice (in Spanish)
Model Non-Creditable Coverage Disclosure Notice (in Spanish)
HSA
Notice to Employees Regarding Employer Contributions to HSA
Newborns and Mothers Health Protection Act
Newborns' and Mothers' Health Protection Act Model Language
USERRA
USERRA: Notice of Your Rights Under USERRA
Wellness Programs
EEOC Wellness Notice
Notice of Availability of Reasonable Alternative Standard
WHCRA
WHCRA: Women's Health and Cancer Rights Act Notice
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