HIPAA Documents

Health Insurance Portability and Accountability Act (HIPAA) is a US law designed to provide privacy standards to protect patients’ medical records and other health information provided to health plans, doctors, hospitals and other health care providers.

Developed by the Department of Health and Human Services, these standards provide patients with access to their medical records and more control over how their personal health information is used and disclosed. They represent a uniform, federal floor of privacy protections for consumers across the country.

General Authorization

Notice of Privacy Practices

Section 125 IRS Code

A Flexible Benefits Plan is a benefit plan governed by Section 125 of the Internal Revenue Code.
By establishing a Flexible Benefits Plan, an organization can allow staff to make pre-tax Health Savings Account contributions or have payroll deductions taken on a pre-tax basis.

A church can ‘adopt’ the Reformed Benefits Association Master Flexible Benefits Plan Document by utilizing the series of documents provided in this section.

To Begin:  Review the document Information and Instructions for Master Flexible Benefits Plan.  Detailed, step-by-step instructions are listed on page 3 of this document.   A copy of the SPD can be obtained by contacting RBA directly.

Please note: these forms should be retained at the church. RBA does not need a copy of any of these forms.

Information and Instruction for Master Flexible Benefits Plan

Master Flexible Benefits Plan Document

Adoption Agreement for Master Flexible Benefits Plan

Resolution for the Establishment of a Flexible Benefits Plan

Medical Only Pre-Tax Election Form

Medical and HSA Pre-Tax Election Form

HSA Election Form