양식
다음은 Carewell 혜택에 등록하거나 갱신하는 데 필요한 모든 필수 양식입니다. 양식은 혜택 또는 범주별로 구성됩니다.
양식을 보려면 혜택 또는 범주를 선택하십시오.
치과
Vision + Hearing
Employee Assistance Program
Healthcare Cost Assistance
유급 휴가
COVID-19 자료
중요 – 정보를 최신 상태로 유지하십시오.
To be eligible for Carewell benefits, the Benefit Administrative Office must have your name, gender, Social Security Number, birthdate, and current address on file. You should also make sure that your information is up to date with the State. Note: Submitting this information will enable the Benefits Administrative Office to enroll you in Carewell SEIU 503 Dental, Vision + Hearing, and Employee Assistance Program benefits if you are eligible.
- Submit the form above to update your information with the Benefits Administrative Office
- Follow the instructions below to update your personal information with the State depending on what type of worker you are.
홈 케어 종사자(HCW)
지역 APD/AAA 현장 사무소에서 주소를 업데이트하십시오. 지역 HCW 코디네이터/담당자에게 연락해는 것이 좋습니다.
OHA 개인 지원 간병인(PSW)
이 제공자 정보 업데이트 양식(PDF)을 작성하여 OHA에 귀하의 현재 정보가 기록되어 있도록 하십시오. 양식에서 다음을 제외한 모든 섹션을 작성하십시오.
- "조직, 그룹 또는 대행사의 경우 이 섹션을 작성하십시오."
- "분류 코드 변경"
Our digital forms are generally available in Spanish, Russian, Vietnamese, and Simplified Chinese. To fill out the form in your preferred language, click on the US flag in the top right corner of the form, and then select your preferred language.
치과
Vision + Hearing
Employee Assistance Program
Healthcare Cost Assistance
승인 플랜의 경우
2022 Annual Paperwork
These forms give the Carewell SEIU 503 Benefits team permission to assist you with enrolling in and maintaining your healthcare coverage. This paperwork is not an application for health insurance.
2022 HIPAA Authorization
2022 Statement of Understanding
2022 RISE Partnership Community Assistance Consent Form
2022 OHA Community Assistance Consent Form
Consent to Release Information Form
Fill this out if you need to allow a trusted family member or friend to make inquiries, schedule appointments, or confirm information on your behalf.
Healthcare Cost Assistance
Medicare의 경우
Ameriflex 상환 양식
Medicare 서류
Consent to Release Information Form
Digital Form
Fill this out if you need to allow a trusted family member or friend to make inquiries, schedule appointments, or confirm information on your behalf.