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Group Agents
- Quotes (2-50)
- Quotes (51+)
- Corporate Reports
- Medical Plans
- Dental Plans
- Underwriting Guidelines
- Enrollment
- Forms & Resources
- Customer Service
- 888-374-8906
- Marketing
- 888-374-8910
Forms & Resources
Resources
- Group Application 2-50 (Excel)
- Group Application 2-50 (PDF)
- Group Application 51+ (Excel)
- Explanation Of Benefits (EOB) sample - Dental (PDF)
- Explanation Of Benefits (EOB) sample - Medical (PDF)
- COBRA continuation premium reductions FAQs
- ODS Rx2.0 Prior Authorization list (PDF)
- ODS Rx2.0 Preferred Drug List (PDF)
- ODS Rx2.0 FAQ (PDF)
Claims
- Medical Claim Form (PDF)
- Dental Claim Form (PDF)
- Prescription Drug Claim Form for Major Medical Plans (PDF)
- Prescription Drug Claim Form for Med Impact Plans (PDF)
- Prescription Compound Drug Claim Form (PDF)
Enrollment for Employee
- Dental Only Enrollment (PDF)
- Medical Only Enrollment (PDF)
- Medical and Dental Enrollment (PDF)
- Declination of Dental Coverage (PDF)
- Declination of Medical Coverage (PDF)
- Affidavit of Domestic Partnership for qualified plans (PDF)
- Health Statement for groups 2-50 (PDF)
Producer Appointments
- Producer Appointment Checklist (PDF)
- Producer Appointment Application (PDF)
- Producer Agreement (PDF)
- Commission Schedule (PDF)
- Commission Assignment (PDF)
- Web User Agreement (PDF)