Shopping for members
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2026 Commercial Member 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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2026 Enrich Tiered Employer Certificate
Provides specific coverage details for your policy
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2026 Large Employer Certificate
Provides specific coverage details for your policy
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2026 Member Prescription Drug Reimbursement Request
Complete this form to submit a prescription drug reimbursement claim
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2026 Transitional Employer Certificate
Provides specific coverage details for your policy
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Amendment to Certificate of Coverage - Domestic Partner Eligibility - Non-governmental Groups Only
Provides possible changes to the Certificate of Coverage
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Autorización para usar y divulgar información médica protegida (HIPAA, por sus siglas en inglés)
Utilice este formulario para designar a las personas que usted elija para que tengan acceso a su información médica
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Care My Way® Brochure
A brochure about our 24-hour Nurse Line and Care My Way® services
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Certificado de Empresa de Transición de 2026
Proporciona detalles de cobertura específicos de su póliza
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Certificado de Empresa Mayor de 2026
Proporciona detalles de cobertura específicos de su póliza
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Certificado Enrich 2026 de empleador escalonado
Proporciona detalles específicos de la cobertura de su póliza
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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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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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Employer Automatic Premium Payment Plan
Informational brochure and form for employers about setting up an automatic premium payment plan
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Enrich Tiered Plan member handout
Learn about Enrich Tiered plans
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Existing Subscriber Health Plan Change Request
Complete this form if you have a demographic change, plan change or the addition or deletion of a dependent
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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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Medication Coverage Options
Learn what drugs are covered with your plan, their cost and network pharmacies
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Solicitud de seguro de salud para empleados (con cuestionario médico)
Los empleados de grupos de empleadores grandes y pequeños nuevos con cobertura totalmente asegurada pueden completar este formulario para solicitar cobertura de seguro de salud.
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Solicitud de seguro de salud 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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Special enrollment rights
A notice about special enrollment provisions
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Wellness Brochure
Learn about the wellness programs we offer employers to keep employees healthy and productive