Forms and Documents

Need a form to help a client enroll in one of our health plans? Or do you have clients already enrolled in our plans who need claim or other forms?

Enrollment forms

Use these forms to help your group clients apply for coverage.

General

Tobacco Usage Form

Chamber Blue

Level Funded

10-50 lives

Administrative Services Agreement Benefit Selection Health Statement

Fully Insured

51+ lives

Certificate of Coverage Benefit Selection Membership Application

SCMC

Level Funded

10-50 lives

Administrative Services Agreement Benefit Selection Health Statement

Fully Insured

51+ lives

Certificate of Coverage Benefit Selection Membership Application

Chamber Exclusive

Level Funded

10-50 lives

Administrative Services Agreement Benefit Selection Health Statement Membership Application