Forms

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Many of the following forms are interactive PDF forms. Please type or print legibly the information into them, print, and obtain signatures.

Forms may be sent via mail, by fax, or scanned and sent via email. Please maintain originals for your files.

MMEHT
60 Community Drive
Augusta, ME 04330
FAX: (207) 624-0166
E-mail: [email protected]

Employer Forms

Medical Enrollment - Change Form Medical Enrollment - Change Form
Rank: 080
Dental Enrollment - Change Form Dental Enrollment - Change Form
Rank: 070
Income Protection Plan Enrollment Form Income Protection Plan Enrollment Form
Rank: 060
Vision Enrollment - Change Form Vision Enrollment - Change Form
Rank: 050
Life Enrollment - Change Form Life Enrollment - Change Form
Rank: 040
Domestic Partner Affidavit Domestic Partner Affidavit
Rank: 020
Employer Contributions Reporting Form Employer Contributions Reporting Form
(This completed form must be returned along with your Remittance Form and monthly payment.) Rank: 010

Salary Change Form (Excel) Salary Change Form (Excel)
Rank: 040
Termination Notification Form Termination Notification Form
Rank: 030
Retiree Eligibility Form Retiree Eligibility Form
Rank: 020
Change of Address Form Change of Address Form
Rank: 010

HIPAA Authorization Form HIPAA Authorization Form
Rank: 010

To obtain Plan Summaries, please refer to the page for the appropriate benefits program.