ASCII Group, LLC
ASCII Group, LLC
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    • Home
    • About Us
    • Services
    • Careers
    • Customers
    • Contact Us
    • Employees
    • COVID-19
  • Home
  • About Us
  • Services
  • Careers
  • Customers
  • Contact Us
  • Employees
  • COVID-19

Employee Documents

Enrollment Form (pdf)Download
ASCII Groups LLC - Premium Conversion Election Form and Salary Reduction Agreement (pdf)Download
ASCII Groups LLC - (POP) Summary Plan Description(SPD) (pdf)Download
COBRA General Notice (pdf)Download
Marketplace model notice (pdf)Download
HIPAA Notice of Special Enrollment Rights (pdf)Download
HIPAA Notice of Privacy Practices (NPP) (pdf)Download
CHIPRA Model Notice (pdf)Download
Medicare Part D Model Notice - for 60+ (pdf)Download
Model WHCRA Enrollment Notices (pdf)Download
Patient Protection Model Notice (pdf)Download

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