Documents & Forms
Quickly narrow your plan choices by selecting options below.
The forms and materials available on this page are not specific to any particular plan. If you have questions about your plan's coverage, please check your benefit materials, or contact our Customer Service Department.
2020 ID Group Master Application (Medical/Dental)
2020 MT Group Master Application (Medical/Dental)
2020 OR Group Master Application (Medical/Dental)
2020 WA Large Group Enrollment Application and Waiver of Coverage
2020 WA Large Group Master Application (medical)
2020 WA Small Group Master Application (medical)
2021 ID Large Group Master Application (Medical/Dental)
2021 ID Small Group Master Application (Medical/Dental)
2021 ID/MT/WA Employee Enrollment and Waiver Form (Medical/Dental)
2021 MT Large Group Master Application (Medical/Dental)
2021 MT Small Group Master Application (Medical/Dental)
2021 OR Employee Enrollment and Waiver Form (Medical/Dental)
2021 OR Large Group Master Application (Medical/Dental)
2021 OR Small Group Master Application (Medical/Dental)
2021 WA Large Group Master Application (medical)
2021 WA Small Group Master Application (medical)
COBRA Election Form Federal Template (WA)
COBRA Initial Notice Template (WA)
Common Ownership Form
Coordination of Benefits
Employer Exemption Certification for Religious or Moral Objections
Group Authorization Agreement for Recurring Electronic Fund Transfers (EFT)
Group Coverage Continuation Election Form (WA small group)
Group Identification Form
Renewal Confirmation Form
RightFit Plan and PCP Selection Form (Washington only)
2020 ID Large Group Brochure
2020 ID Large Group Brochure - Dental Only
2020 ID Sample Limitations and Exclusions (Medical)
2020 ID Small Group Brochure
2020 MT Large Group Brochure
2020 MT Large Group Brochure - Dental Only
2020 MT Small Group Brochure
2020 OR Large Group Brochure
2020 OR Large Group Brochure (Dental Only)
2020 OR Small Group Brochure
2020 WA Large Group Brochure
2020 WA Small Group Brochure
2021 ID Large Group Brochure
2021 ID Large Group Brochure - Dental Only
2021 MT Large Group Brochure
2021 MT Large Group Brochure - Dental Only
2021 OR Large Group Brochure
2021 OR Large Group Brochure - Dental Only
2021 WA Large Group Brochure
Employer Administration Manual
Large Group ID Self-Funded Dental Flier
Large Group MT Self-Funded Dental Flier
Large Group OR Self-Funded Dental Flier
Medicare Notice A (creditable) Sample member Notice
Medicare Notice B (noncreditable) Sample member Notice
Medicare Part D Creditable Coverage FAQ
Medicare Part D Employer Creditability Notice
Medicare Part D ID 2020 Creditability Matrix
Medicare Part D ID 2021 Creditability Matrix
Medicare Part D MT 2020 Creditability Matrix
Medicare Part D MT 2021 Creditability Matrix
Medicare Part D OR 2020 Creditability Matrix
Medicare Part D OR 2021 Creditability Matrix
Medicare Part D WA 2020 Creditability Matrix
Medicare Part D WA 2020 Creditability Matrix
Pharmacy Product Guidelines FAQ
Self-Funded Administrative Solutions