- Generic Forms and Notices
- Dental
- Medical
- Vision
- Group Term Life
- Short Term Disability
- Long Term Disability
- Continuation of Coverage for Disabled Dependents Form PDF
- Language Assistance Program Notice (for CA groups) PDF
- HIPAA Notice English | Spanish
- Termination Form (for terming an employee's coverage) Word | PDF
- COBRA Form PDF
Idaho Universal Employee Enrollment Form
PDF
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Ohio Uniform Employee Application
PDF
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Utah Universal Employee Enrollment Form
PDF
- Dental Group Roster (to enroll employees) Word | PDF | Excel
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CA English Dental Only Enrollment Form
Word |
PDF
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CA Spanish Dental Only Enrollment Form
Word |
PDF
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CA English Dental/Vision Enrollment Form
Word |
PDF
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CA Spanish Dental/Vision Enrollment Form
Word |
PDF
- English Dental Only Enrollment Form Online | Word | PDF
- Spanish Dental Only Enrollment Form Word | PDF
- English Dental/Vision Enrollment Form Online | Word | PDF
- Spanish Dental/Vision Enrollment Form Word | PDF
- Affidavit of Domestic Partnership Form Word | PDF
- Dental Claim Form PDF
Health Solutions II - Co-pay PPO
- Health Solutions II Enrollment Form (National) Online | Word | PDF
- Health Solutions II Enrollment Form (Texas) Online | Word | PDF
- Health Solutions II Enrollment Form (Arizona) PDF
- Idaho Universal Employee Enrollment Form PDF
- Illinois Standard Health Application (for employees) PDF
-
Ohio Uniform Employee Application
PDF
- Utah Universal Employee Enrollment Form PDF
- Group Medical Claim Form PDF
- CVS Caremark Mail Order Form PDF
- View a Current Drug List PDF
- CVS Caremark Prescription Drug Claim Form PDF
Health Solutions I - HDHP
- HDHP Employee Enrollment Form Online | Word | PDF
- HDHP Employee Enrollment Form (Texas) Online | Word | PDF
- HDHP Employee Enrollment Form (Arizona) PDF
- Idaho Universal Employee Enrollment Form PDF
- Illinois Standard Health Application (for employees) PDF
-
Ohio Uniform Employee Application
PDF
- Utah Universal Employee Enrollment Form PDF
- Group Medical Claim Form PDF
- CVS Caremark Mail Order Form PDF
- View a Current Drug List PDF
- HDHP Prescription Drug Claim Form PDF
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Ohio Uniform Employee Application
PDF
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Utah Universal Employee Enrollment Form
PDF
- Vision Group Roster (to enroll employees) Word | PDF | Excel
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Vision Indemnity Claim Form
PDF
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Vision PPO Out-of-Network Claim Form
PDF
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Ohio Uniform Employee Application
PDF
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Gold, Silver and Bronze Life Enrollment Form
Word |
PDF
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Essential Life Enrollment Form
Word |
PDF
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Passport Life Enrollment Form
Word |
PDF
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Flex Life Enrollment Form
Word |
PDF
- Group Term Life Roster (to enroll employees) Word | PDF | Excel
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Employee Death Benefits Claim Form
PDF
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Dependents Death Benefits Claim Form
PDF
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Accelerated Benefits Claim Form
PDF
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Waiver of Premium Claim Form
PDF
- Illinois Standard Health Application (for employees) PDF
- Short Term Disability Enrollment Form Word | PDF
- Short Term Disability Enrollment Form (Kentucky) Word | PDF
- Group Roster (for groups with no late entrants) Word | PDF | Excel
- STD Waiver of Coverage PDF
- STD Claim Form Word | PDF
- Long Term Disability Enrollment Form Word | PDF
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Ohio Uniform Employee Application
PDF