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Sample Plan Documents for current customers:

Current Sample Plan Document

Enter your Tax Identification Number and ZIP Code to download the most current Sample Plan Document in its entirety, along with your Plan Information Summary.

Note: If you have multiple plans using the same Tax Identification Number, please call your local Aflac agent to obtain your current Sample Plan Document packet.

If you do not have Adobe Reader, please download it here.

Special Enrollment Rights Expansion Sample Amendment

To download a sample amendment to incorporate the new special enrollment rights created by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), click here.

Recent legislation signed into law, the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), creates new special enrollment rights for employees and dependents who lose coverage under a Medicaid or a State Children's Health Insurance Program under titles XIX and XXI of the Social Security Act. Although most cafeteria plan documents include HIPAA special enrollment rights under Code Section 9801(f), many plans likely do not allow for a 60-day election period. (As is the case with our sample cafeteria plan documents since past special enrollment rights had only a 30-day timeframe). Thus, a plan amendment would be necessary in order to reflect the provisions granted by the new law (CHIPRA).

The affect on cafeteria plans is quite minor compared to interaction with health plans, but action is needed nonetheless.