Employer documents
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2027 Commercial Handbook
A quick-start guide for individual and fully-ensured employer plan members to understand their health plan and find the information they need
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2027 Employee Health Insurance Application WITH medical questionnaire
Employees of new fully-insured, large employers and new level-funded employers may complete this form to apply for coverage
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2027 Employee Health Insurance Application WITHOUT medical questionnaire
Employees of new fully-insured, small employers and all existing employers may complete this form to apply for coverage
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2027 Employer Health Insurance Application
Application form for employers to apply for group coverage for employees
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2027 Enrich Tiered Employer Certificate
Provides specific coverage details for your policy
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2027 Large Employer Certificate
Provides specific coverage details for your policy
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2027 Large Employer Certificate - Spanish
Proporciona detalles de cobertura específicos de su póliza
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2027 Small Employee Coverage Customer Guide
This guide outlines the health care coverage and extra benefits available to members
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2027 Solicitud de seguro médico para empleados - con cuestionario médico
Los empleados de empleadores grandes existentes y de empleadores pequeños nuevos o existentes pueden completar este formulario para solicitar cobertura.
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2027 Solicitud de seguro médico para empleados: sin cuestionario médico
Los empleados de empleadores grandes existentes y de empleadores pequeños nuevos o existentes pueden completar este formulario para solicitar cobertura.
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2027 Transitional Employer Certificate
Provides specific coverage details for your policy
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Certificado de Empresa de Transición de 2027
Proporciona detalles de cobertura específicos de su póliza
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Employer Portal Access Request
Employers should complete this form to get initial access to the employer portal
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Enrich Large Group Sell Sheet
Learn about our Enrich plan, offering exceptional coverage with local providers
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Enrich Tiered Plan Member Handout
Learn about Enrich Tiered plans
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Enrich Tiered Plan Sell Sheet
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Group Insurance Policy Template
Contains up-to-date language found in the current Group Insurance Policy
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HIPAA Authorization to Use and Disclose Protected Health Information
Use this form to designate individuals you choose to have access to your health information
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Large Employee Coverage Customer Guide
This guide outlines the health care coverage and extra benefits available to members
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Premier Large Employer Sell Sheet
Learn about our Premier plan, offering exceptional coverage with local providers.
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Renewal Questionnaire
A renewal questionnaire is a form completed by employers during the health insurance renewal process.
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SimplyOne Large Employer Sell Sheet
Learn about our SimplyOne plan, offering exceptional coverage with local providers
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Solicitud de cambios del suscriptor
Complete este formulario si tiene un cambio demográfico, un cambio de su plan o la incorporación o eliminación de un dependiente