Open Enrollment: October 16 to November 8, 2024 for 2025 plan year

• HMSA Annual (Open) Enrollment letter with rates for 2025
• ​Benefits At-a-Glance for 2025 (comparison guide)
• 2025 Summary of Benefits Med 734/Drg 860/Vis 0GA/Den C51 
• 2025 Summary of Benefits Med 735/Drg 860/Vis 0GA/Den C54
• 2025 Summary of Benefits Med Q-A/Drg 861/Vis 0HA/Den C51
• 2025 Summary of Benefits Med Q-A/Drg 861/Vis 0HA/Den C54
• 2025 Renewal Brochure
• 2025 Dental Flyer
• 2025 Vision Flyer
• 2025 Drug Flyer​
• For additional resources from HMSA, please visit their website HERE

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Documents for Employees

Documents below are available to be downloaded, you may click on the link to do so:

HMSA documents

• Application
• Well-Being Guide
• Premiums Rates for plan year 2025
• Benefits At-a-Glance 2025​
• We're Here For You Brochure
• HMSA's Online Care
• Behavioral Health Program
• My Account Guide
• Online Care Rack Card
• Travel with HMSA flyer

ACA required documents for ELIGIBLE employees (even if they decline coverage)

• Healthcare Compliance Notices 2022
• No Surprises Act Notice
• Nondiscrimination Notice 
• ACA Model Cover Letter to Employees (ask your church for a copy)
• ACA Model Notice Health Plan (ask your church for a copy)
  
  

ONLY IF the employee is eligible, but declines health insurance​

• HC-5 Form for 2024
• HC-5 Form for 2025

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Documents for Employers to complete and then give to Employee(s)

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• ACA Model Cover Letter to employee
  • Copy and paste the ACA Model Cover Letter to Employees to your church's letterhead, make appropriate changes, sign, and give to the employee.
• ACA Model Notice Health Plan
  • Complete yellow highlighted question 13.