Va. Admin. Code tit. 14, agency 5, ch. 405, form FORMS (14VAC5-405)

Current through Register Vol. 41, No. 10, December 30, 2024

Form - FORMS (14VAC5-405)

Notice of Consumer Rights, Form 405-A (rev. 9/2022)

Elective Group Health Plan Opt-In, Form 405-B (rev. 3/2021)

Elective Group Health Plan Change/Termination, Form 405-C (rev. 3/2021)

Notice of Intent to Arbitrate, Form 405-D (rev. 9/2022)

Arbitrator Application, Form 405-E (rev. 3/2021)

Va. Admin. Code tit. 14, agency 5, ch. 405, form FORMS (14VAC5-405)

Derived from Virginia Register Volume 37, Issue 07, eff. 1/1/2021.

Statutory Authority: 12.1-13 and 38.2-223 of the Code of Virginia.