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?
Use these forms to help your group or individual clients apply for coverage. These forms are also included on the individual plan pages in our Products and Services section.
- Enrollment Checklist
- Small Group Enrollment Tool*
- Group Rework Agent Checklist
- Membership Application
- Tobacco Usage Form
- Agent Compliance Attestation Form
BlueMeasureSM - Level Funded Plans
- BlueMeasure Enrollment Checklist
- BlueMeasure Census*
- BlueMeasure Health Statement
- BlueMeasure Benefit Selection
- BlueMeasure Membership Application
- BlueMeasure EFT Form
- AccrueHealth Enrollment Census
- AccrueHealth New Group Checklist
- Administrative Services Terms and Conditions
- Plan of Benefits
- ICHRA Administrative Services Agreement
- ICHRA Electric Funds Transfer Authorization Form
- ICHRA Employee Enrollment Form
- Payroll Express Program Brochure
We offer life insurance through Companion Life. Companion Life is a separate company responsible for all services related to life insurance.
- Companion Life Employer Participation Application
- Companion Life Group Application
- Companion Life RFP
Do your clients need forms to manage their benefits? Our Members section includes a full library of forms, including claims, prescription drugs, HIPAA authorization and bank draft forms — and more.
*All items marked with an asterisk will download as an external file