Keenan HealthCare - Resources

Please click here for directions on how to access and download forms within an Administrative Guide.

Name	Protected	Download		Notes
		English	Spanish
Medicare Secondary Payer RequirementsWe have assembled a group of documents to assist you with the Medicare Secondary Payer provisions and MSP Demand Letter Process.				Updated 6/09
Medicare Payer Data Collection Form Information regarding your Health Plan and Medicare
MetLife Premium StatementComplete this statement on the first of each month to calculate the total premium due.
Out-of-Network Providers BrochureFacts you need to know about Out-of-Network Providers.
COBRA Continuation Coverage Administration ManualQuick reference and easy access to the tools you need for COBRA administration.				updated for 2010
COBRA Continuation Coverage Administration Manual FormsQuick reference and easy access to the tools you need for COBRA administration.				updated for 2010
HIPAA Resource GuideInformation guide about HIPAA regulations.				Updated for 2010
MetLife Admin GuideThis Admin Guide is designed to assist you in the administration of your MetLife Insurance Program.				Revised 2/01/2009
Prudential Basic Life & AD&DThis Admin Guide is designed to assist you in the administration of The Prudential Insurance Company of America Basic Life and AD&D Program.
Prudential Voluntary/Optional AD&DThis Admin Guide is designed to assist you in the administration of The Prudential Insurance Company of America Voluntary/Optional Life Program.
Prudential Voluntary/Optional LifeThis Admin Guide is designed to assist you in the administration of The Prudential Insurance Company of America Voluntary/Optional AD&D Program.

Name	Protected	Download		Notes
		English	Spanish
Briefing - Predesignations March 2006These rules and regulations provide clarification regarding how an injured employee must predesignate their personal treating physician and exactly what type of physicians can be predesignated.				Published 3/06
WC Benefits SummaryInformation about your Workers' Comp benefits.				Revised 7/09
Posting NoticeFlyer to post that explains what to do when an injury occurs at work.				Revised 6/04
New Hire PamphletHand-out for employees that explains Workers' Comp benefits.				Revised 6/07
Personal Physician Request and Acknowledgement FormYou must notify your employer ,in writing, prior to being injured on the job and provide written verification that your personal physician meets the above requirements and agrees to be predesignated to be eligible.				Revised 7/07
Notice of Personal Chiropractor or Personal Acupuncturist FormTo be eligible you must notify your employer in writing prior to being injured.
Notice of Potential Eligibility/DWC-1Instructions for submitting a Workers' Comp claim.				State Version 8/04
DWC-1 Claim FormState of California Workers' Comp Claim Form.				State Version 8/04
Compliance Kit Order FormOrder printed copies of the WC forms to be mailed to your organization.				Revised 10/06

Name	Protected	Download		Notes
		English	Spanish
PRIME Rx Introductory LetterIntroduction to Prime Rx for program administrators.
PRIME Rx Temporary Prescription Services IDWC Temporary Prescription Services ID form that can be presented to your pharmacist when you fill your initial prescription using the Prime Rx program.