Small Group Forms
Affidavit of Extended Dependent Eligibility
Appointment of Representative (Group members)
Employee Status Change Form
Member Disclosure Form
Pharmacy Transition of Medications
Waiver of Coverage
Employer Risk Questionnaire
Medical Transition of Care
Continuation of Coverage (mini-cobra)
Common Ownership Form
COBRA form
Contractor Relationship - 1099 Affidavit
PEO Questionnaire Form
Small Group Employee Enrollment Form
Small Group Submission Deadline Calendar
Small Group Underwriting Guidelines (Effective 1/1/17)
Small Group Underwriting Guidelines (Effective 1/1/18)
Small Group Case Submissions Checklist
2017 Small Group Master Application
2018 Small Group Master Application
Large Group Forms
Affidavit of Extended Dependent Eligibility
Appointment of Representative (Group members)
Employee Status Change Form
Member Disclosure Form
Pharmacy Transition of Medications
Waiver of Coverage
Employer Risk Questionnaire
Medical Transition of Care
COBRA form
Large Group Submissions Checklist
Large Group Commission Rate Agreement Form
Large Group Employee Enrollment Form
Large Group Underwriting Guidelines