Eligibility Forms and Notices

Following you will find links to forms and notices pertaining to your Franklin County Cooperative Health Plan.

• Medicare Request Form
• Dependent Eligibility Beyond Limiting Age
• Transfers, Rehire, Newly Eligible Employees - Management Use Only

Below you will find links to forms and notices pertaining to the ThriveOn wellness program.

• Biometric Screening Form (for WorkHealth and PCP)
• 2025 Proof of Exam Form (for annual physicals, preventive screenings, vision/dental exams, etc.)
• Notice of Employer Sponsored Wellness Program
• Reduced Deductible Appeal: Please come back after September 1 to complete your Reduced Deductible Appeal. If you have questions regarding the current status of your incentive please contact ThriveOn@franklincountyohio.gov or 614.525.3948.

   

Not finding what you are looking for? Please view a listing of our other programs.