Forms and Documents

Here you'll find all the forms you need for program enrollment, account maintenance, supplies and more.

Forms

Applications

Underwriting

  • Merit Group Request for Proposal PDF Document
    This form is completed by Sales Representatives and District Sales Managers with the group's insurance information. This will prompt the Underwriting work area to produce a quote.
  • Small Group Worksheet PDF Document
    Sales Represesentatives and District Sales Managers complete the Small Group Worksheet, which must be attached to the customer's employee health statements. The Employer Group Listing is provided to the Underwriting work area to produce a quote.
  • UW15A PDF Document — Potential Employer Contribution Form 1
  • UW15B PDF Document — Potential Employer Contribution Form 2
  • UW Release for Medical Records PDF Document