Note: These forms are the most common ones that you'll need. Not all online forms are ready yet for these new products, but we'll add them here as they become available.

• Group Master Applications
  • Effective dates 8/1/08 and beyond
    • Groups 2-99 Employees (PDF)
    • Groups 100+ Employees (PDF)
  
  
• Dual Option Guidelines (Groups 51+) (PDF)
• Application for Enrollment/Change (PDF)
• Waiver Form
• Affidavit of Qualifying Domestic Partnership (PDF)
• Affidavit of Qualifying Incapacitated Dependent Eligibility (PDF)
• Online Enrollment Set-Up Checklist (PDF)
• Employer Center Setup Form (PDF)
• Surepay Authorization Form (PDF)
• Employer Documentation: Groups of 2 or 3 Employees (PDF)
• Authorization for Use and Disclosure of Protected Health Information (PDF)
• Group Administrator Manual (PDF) For Embark and Vantage plans only. Your first resource in administering the coverage selected by your company. General information about enrollment, billing, and appeals procedures.

Spanish Language Forms / Formularios en Español

• Waiver Form / Formulario de renuncia
• Application for Enrollment/Change / Solicitud de inscripción/cambio
• Group Master Application / Solicitud Grupal Principal
• Authorization to Disclose Health Information / Autorización para Divulgar Información Protegida de Salud