Downloads

Forms & Documents

All documents below are in the form of PDFs.

09-10 Paper Application/Authorization Form Only use this form to enroll if you are unable to enroll using our online system at hwtrust.geouaw.org. Using the paper form, as opposed to the online enrollment system, will slow the processing of your application. You do not need to submit a separate authorization form when using the paper application.
09-10 Enrollment Packet This is enrollment information booklet, which was mailed via hard copy to all eligible grad employee's departmental mailboxes. This booklet describes all benefits in detail, as well as providing information about how to enroll, costs, eligibility, COBRA, etc.
09-10 Wellness Reimbursement Form This is a Wellness Reimbursement Form for those turning in receipts separate from their dental and vision application. The deadline for submitting 2009-10 receipts for this reimbursement is June 30, 2009.
09-10 COBRA Application This is the COBRA application form for those who lose their eligibility on or after 10/1/09. This form is ude within 60 days of your lose of coverage date
Important Information About Your COBRA Continuation Coverage Rights Contains detailed information about your COBRA Continuation Coverage Rights, including information on what continuation of coverage is, how long coverage can be continued or extended, who is eligible, costs, etc.
ARRA Premium Reduction Form This form relates to eligibility for premium reductions for the COBRA plan and should be viewed in conjunction with the COBRA application above.
Form to Switch COBRA Options This form allows you to switch your COBRA coverage options.
COBRA Participant Notification Form This form is designed for COBRA qualified beneficiaries who are paying reduced premiums pursuant to ARRA so they can notify us if they become eligible for other group dental and/or vision care.
Summary of the ARRA Provisions This is a summary of the COBRA Premium Reduction Provisions under the American Recovery and Reinvestment Act (ARRA), produced by the Department of Labor.
09-10 Delta Dental Plan Description Delta Dental Plan description providing details on coverage levels, deductibles, plan year maximums and other information.
Delta Dental Subscriber Certificate Delta Dental certifies that you have the right to benefits for services according to the terms of your contract. This certificate is part of your contract.
09-10 EyeMed Plan Description EyeMed plan description providing details on coverage levels, copayments, discounts and other information.
Delta Roll-over Max Explanation Information on Delta's new Roll-over Max Benefit, which will begin to be accessible to GEO members as of 11/1/09.
Delta Dental Claim Form Use this form to submit a claim for insurance coverage.
EyeMed Claim Form Use this form to submit a claim for insurance coverage.
Delta Roll-over Max Example An illustration showing how the roll-over max could benefit you.
09-10 Blank Authorization Form Only use this form if you are unable to print your customized authorization form using our online system at hwtrust.geouaw.org. Using this blank form, as opposed to the one generated by the online enrollment system with your customized information, will slow the processing of your application.
09-10 Frequently Asked Questions Answers to your frequently asked questions.
HIPPA Policy Information about HIPPA, the law which protects the privacy of your health information, and our practices under this law.