Employer's Forms
Below is a list of forms for employer groups that are available to the public. Additional forms may be available to you after you sign into the Employer Portal [opens in a new window].
- Large Group Enrollment and Change Form [opens in a new window]
- Small Group Enrollment and Change Form [opens in a new window]
- COBRA Election Form [opens in a new window]
- Common Law Marriage [opens in a new window]
- Coordination of Benefits (COB) Form [opens in a new window]
- Employer Billing Key Code [opens in a new window]
- Protected Health Information (PHI) Authorization Form
- Request for Dependent Coverage Due to Incapacitation [opens in a new window]
- Employer Portal User Guide [opens in a new window]
