Agents
AvMed makes it easy to manage your account by providing forms and other tools for making requests. Simply print and fill out one of our pre-composed forms for quick, easy service. Certain requests can be submitted directly online.
Small Group Forms
Employee Status Change Form
PDF, 223 KB
PDF, 223 KB
Member Disclosure Form
PDF, 208 KB
PDF, 208 KB
Employee Waiver of Coverage
PDF, 97 KB
PDF, 97 KB
Employer Risk Questionnaire
PDF, 181 KB
PDF, 181 KB
Employee Enrollment Form
PDF, 114 KB
PDF, 114 KB
Common Ownership Form
PDF, 93 KB
PDF, 93 KB
COBRA Application
PDF, 206 KB
PDF, 206 KB
PEO / Employer Questionnaire
PDF, 122 KB
PDF, 122 KB
Master Application (Small Group)
PDF, 298 KB
PDF, 298 KB
Large Group Forms
Employee Status Change Form
PDF, 223 KB
PDF, 223 KB
Employee Enrollment Form
PDF, 114 KB
PDF, 114 KB
Member Disclosure Form
PDF, 208 KB
PDF, 208 KB
Employee Waiver of Coverage
PDF, 97 KB
PDF, 97 KB
Employer Risk Questionnaire
PDF, 181 KB
PDF, 181 KB
COBRA Application
PDF, 206 KB
PDF, 206 KB