Employer Forms



Dental & Vison Master Applications

Employer Dental PPO & Vision Master Applications

PDF

   

Employer Dental PPO & Vision Master Applications
Arizona & Nevada

PDF

   

Employer Dental PPO & Vision Master Applications
California

PDF

   

Employer Dental PPO & Vision Master Applications
Texas

PDF

   

Employer Topaz Dental PPO and Vision Master Applications
Utah

PDF

   

Employer Dental IndemnityPlus & Vision Master Applications

PDF

   

Employer Dental IndemnityPlus & Vision Master Applications
Arizona & Nevada

PDF

   

Employer Dental IndemnityPlus & Vision Master Applications
California

PDF

   

Employer Topaz Dental IndemnityPlus & Vision Master Applications
Utah

PDF

   





Vision Master Applications

Employer Access Vision Master Applications

PDF

   

Employer Vision PPO Master Applications

PDF

   





Life Master Applications

Employer Gold, Silver & Bronze Life Master Applications

PDF

   

Employer Gold, Silver & Bronze Life Master Applications
Texas

PDF

   

Employer Essential Life Master Applications

PDF

   

Employee Group Term Life Roster

PDF

   




Short Term Disability Master Applications

Employer Short Term Disability Master Applications

PDF

   





Other Forms

Check by Fax Form

PDF

   

COBRA Form

PDF

   

Continuation of Coverage for Disabled Dependent Form

PDF

   

HIPAA Business Associate Agreement

PDF

   

HIPAA Notice

PDF English

PDF Spanish

 

Language Assistance Program Notice

PDF

   

Census Enrollment Template

PDF