Benefits Forms and Required Notices for New Hires
A comprehensive benefits package with plan options for health care and retirement to take care of our employees today and tomorrow.
Contacts
- Benefits Office
- (505) 667-1806
Forms
- Benefits Enrollment Form, 1751a (pdf)
- Casual Employee Benefits Enrollment Form (pdf)
- Declaration of Domestic Partnership, 1925a (pdf)
- Declaration of Legal Ward as Eligible Dependent, 3028 (pdf)
- Declaration that Enrolled Dependent Meets IRS Requirements for Tax-Favored Health Premium Contributions, 3027 (pdf)
- Universal Beneficiary Designation Change Form, 1938 (pdf)
Required notices
- Required Notices Package (pdf)
Package includes:- Continuation Coverage Rights Under COBRA
- Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
- Notice from LANS about Your Prescription Drug Coverage and Medicare
- Women’s Health and Cancer Rights Act (WHCRA)
- Wellness Reward Alternative
- HIPAA Special Enrollment Rights
- Health Insurance Marketplace Coverage Options
- LANL HIPAA Privacy Notice (pdf)
- Required Annual Notices by Law for Retirees (pdf)
