State of Montana Employer Forms

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  • Petition - For use when a group comes forward requesting a vote
  • Ballot Cover Memo 
  • Ballot - Customize highlighted sections
  • Voting Rules and Best Practices
  • Cover Letter Enrollment Form 
  • Enrollment Form - UPDATED - MUST be filled out by separating employee
  • COBRA Forms - If applicable, fill in and mail as instructed on form
  • Adoption Agreement - The Adoption Agreement allows the Employer to offer VEBA to one or many groups within the Group Structure. This form MUST be sent to the Dept. of Admin. (EBB) prior to a group vote with a description of the proposed group structure. Print sign and mail to: Montana VEBA HRA, PO BOX 200130, Helena, MT 59620-0130.
  • Sample Policy Memos, Union Bargaining Agreements, Memorandum of Understanding, etc. One of these must be chosen and filled out for each group established by an employer. Once the Adoption Agreement (above) is approved, the following (choose the one that suits your structure) must be sent in for each group that forms. For example; City of Helena - Police (1 group), Water Division (1 group), etc.
  • Instructions for Processing Your Payroll -  Please contact Health Care & Benefits, 406-444-3745, for payroll instructions.