Haisten and Johnston PC Forms
Employee Insurance Coverage Notices
- Form 1 - For employers who offer a health plan to some or all employees.
- Form 2 - For employers who do not offer a health plan.
Please click a link below to securely complete the appropriate document. Immediately after signing the document, you will receive a confirmation email from Adobe Document Cloud (our document signing software) to confirm your email address - make sure you check your email and confirm your email address.
Finally, you will receive a confirmation email containing a PDF copy of your signed form. Please keep a copy of the document for your records.