Small Group Forms
New Small Groups
Renewing Small Groups
Continuation Coverage
Medicare
Life
Claim Forms (Health, Dental, Pharmacy)
Other Notices and Forms
- Common Ownership Form – Small Group
- Enrollment Application/Change Form
- Enrollment Application/Change Form – Spanish
- Non-Regulated Small Group (51-100) Census Form
- Non-Regulated Small Group (51-100) Quote Request Form
- Quoting Brochure
- Guide for Submitting Quotes (2-50)
- Quote Requests for Groups with 51-100 Employees
- Regulated Small Group (2-50) Request for Proposal & Census
- Regulated Small Group (2-50) Request for Proposal & Census
- Small Employer Benefit Program Application (for effective dates on and after Jan. 1, 2013)
- Small Group Employer Medical Questionnaire
- Small Group Important Timelines
- Small Group Submission Checklist
- Texas Supplemental Form
- Tips for Submitting Small Groups
- Small Employer Benefit Program Application (Application for Amendment) (for renewal dates on and after Jan. 1, 2013).
- Enrollment Application/Change Form
- Enrollment Application/Change Form – Spanish
- Medicare Secondary Payer (MSP) Employer Acknowledgement Form with Instructions
- Information Regarding Medicare Secondary (MSP) Payer Statue
- HIPAA General Enrollment Rights Notice
- Group Profile Update Form
- COBRA Initial Notice Requirements
- COBRA Application
- Texas Six (6) Month State Continuation Application
- Texas Nine (9) Month State Continuation Application
- Dependent State Continuation Application
- Medicare Secondary Payer (MSP) Employer Acknowledgement Form with Instructions
- Information Regarding Medicare Secondary (MSP) Payer Statue
- MSP Fact Sheet
- Enrollment Application/Change Form
- Enrollment Application/Change Form – Spanish
- Change Life Beneficiary
