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Home
About RCI
About RCI
RCI History
Our Services
Partners
PPO Cost Management
Resources
Employer Resource Center
DOL Compliance Assistance Guide
Regional Care ACA Guide
Affordable Care Act (Additional Information)
Medicare
Cafeteria Plans
ERISA
Family and Medical Leave Act
Employer Required Notices
Self Funding Success
Contact RCI
Forms
Coordination of Benefits
Claims Form (Not For FSA/HSA/HRA/DCAP)
Accident Form
Appointment of Personal Representative Form
Dependent Care Reimbursement Form
Select Flex/HSA/HRA/MERP Reimbursement Form
New Provider Access
Employee Recognition
1095 Worksheet – Sample
Login
1095 Worksheet – Sample
Click here to download the 1095 Sample Worksheet for 2022