Broker Forms
Dental / Vision Master Applications
| Employer Dental / Vision Master Application All Other States |
| Employer Dental / Vision Master Application Arizona & Nevada |
| Employer Dental / Vision Master Application California |
| Employer Dental / Vision Master Application Texas |
| Employer Topaz Dental / Vision Master Application Utah |
Life Master Applications
| Master Application for Gold, Silver & Bronze Life All Other States |
| Master Application for Gold, Silver & Bronze Life Texas |
| Master Application for Essential Life Florida, Louisiana, Missouri, Montana, Oregon, Virginia & Washington |
Short Term Disability Master Applications
Employer Short Term Disability Master Applications Arkansas, DC, Hawaii, Idaho, Illinois, Kentucky, Missouri, Mississippi, Nebraska, New Mexico, Ohio, Pennsylvania, South Carolina, South Dakota, Texas, Utah & Wyoming |
Other Master Applications
| Check by Fax Form |
| ACH Enrollment Form |
Enrollment Rosters & Submission Checklists
| Census Enrollment Template |
| Dental Submission Checklist |
| Dental & Vision Submission Checklist |
| Short Term Disability Submission Checklist |
| Life Submission Checklist |
| Group Life Beneficiary Addendum Form |
| Employee Coverage Termination Form |
Producer Appointment Forms
| Appointment Form |
| Electronic Funds Transfer |
| HIPAA Business Associate Agreement |
| Producer Compensation Disclosure Utah |
| W-9 Form |