Broker Forms

Dental / Vision Master Applications

Employer Dental / Vision Master Application

PDF

   

Employer Dental / Vision Master Application
Arizona & Nevada

PDF

   

Employer Dental / Vision Master Application
California

PDF

   

Employer Dental / Vision Master Application
Texas

PDF

   

Employer Topaz Dental / Vision Master Application
Utah

PDF

   





Life Master Applications

Master Application for Gold, Silver & Bronze Life

PDF

   

Master Application for Gold, Silver & Bronze Life
Texas

PDF

   

Master Application for Essential Life

PDF

   

Employee Group Term Life Roster

PDF

   




Short Term Disability Master Applications

Employer Short Term Disability Master Applications

PDF

   




Other Master Applications

Check by Fax Form

PDF

   




Enrollment Rosters & Submission Checklists

Census Enrollment Template

Excel

   

Short Term Disability Enrollment Roster Template

PDF

   

Dental Submission Checklist

PDF

   

Dental & Vision Submission Checklist

PDF

   

Short Term Disability Submission Checklist

PDF

   

Life Submission Checklist

PDF

   

Group Life Beneficiary Addendum Form

PDF

   

Employee Coverage Termination Form

PDF

Online

 



Producer Appointment Forms

Appointment Form

PDF

   

Electronic Funds Transfer

PDF

   

HIPAA Business Associate Agreement

PDF

   

Producer Compensation Disclosure
Utah

PDF

   

W-9 Form

PDF