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.
2022 ID Large Group Master Application (Medical/Dental)
2022 ID Small Group Master Application (Medical/Dental)
2022 MT Large Group Master Application (Medical/Dental)
2022 MT Small Group Master Application (Medical/Dental)
2022 OR Large Group Master Application (Medical/Dental)
2022 OR Small Group Master Application (Medical/Dental)
2022 WA Large Group Master Application (Medical/Dental)
2022 WA Small Group Master Application (Medical/Dental)
2023 ID Large Group Master Application (Medical/Dental)
2023 ID Small Group Master Application (Medical/Dental)
2023 MT Large Group Master Application (Medical/Dental)
2023 MT Small Group Master Application (Medical/Dental)
2023 OR Small Group Master Application (Medical/Dental)
2023 WA Large Group Master Application (Medical/Dental)
2023 WA Small Group Master Application (Medical/Dental)
Attestation of Eligibility
COBRA Election Form Federal Template
COBRA Initial Notice Template
Common Ownership Form
Coordination of Benefits
Employer Exemption Certification for Religious or Moral Objections - WA
Group Authorization Agreement for Recurring Electronic Fund Transfers (EFT)
Group Authorization Agreement for Recurring Electronic Fund Transfers (EFT) - Self-funded
Group Coverage Continuation Election Form (WA small group)
Group Identification Form - MT, OR, WA
Renewal Confirmation Form
Continuation of Coverage Laws FAQ for Members (Oregon only)
Pharmacy Network for ID, MT, OR, and WA
Pharmacy Network for ID, MT, OR, and WA (Excel format)
Winning at Wellness Workbook
Employer Administration Manual
2023 MT Large Group Brochure - Dental Only
2022 ID Large Group Brochure - Dental Only
2022 ID Large Group Brochure - Navigator
2022 ID Large Group Brochure - Voyager
2022 ID Sample General Medical Limitations and Exclusions
2022 ID Small Group Brochure - Navigator
2022 ID Small Group Brochure - Voyager
2022 Idaho Small Group Dental Exclusions
2022 MT Large Group Brochure
2022 MT Large Group Brochure - Dental Only
2022 MT Small Group Brochure - Navigator
2022 OR Large Group Brochure - Dental Only
2022 OR Large Group Brochure - Navigator
2022 OR Large Group Brochure - Voyager
2022 OR Small Group Brochure - Navigator
2022 OR Small Group Brochure - Voyager
2022 WA Health Plan Disclosure
2022 WA Large Group Brochure - Navigator
2022 WA Large Group Brochure - Voyager
2022 WA Large Group Dental Only Brochure
2022 WA Small Group Brochure - Navigator
2022 WA Small Group Brochure - Voyager
2023 ID Large Group Brochure - Dental Only
2023 ID Large Group Brochure - Navigator
2023 ID Large Group Brochure - Voyager
2023 ID Sample General Medical Limitations and Exclusions
2023 ID Small Group Brochure - Navigator
2023 ID Small Group Brochure - Voyager
2023 Idaho Small Group Dental Exclusions
2023 MT Large Group Brochure - Dental Only
2023 MT Large Group Brochure - Navigator
2023 MT Small Group Brochure - Navigator
2023 OR Small Group Brochure - Navigator
2023 OR Small Group Brochure - Voyager
2023 WA Health Plan Disclosure
Balance Billing Protection Notice for ID
Balance Billing Protection Notice for MT
Balance Billing Protection Notice for OR
Balance Billing Protection Notice for WA
Employer Administration Manual
Large Group ID Self-Funded Dental Flier
Large Group MT Self-Funded Dental Flier
Large Group OR Self-Funded Dental Flier
Large Group WA 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 2021 Creditability Matrix
Medicare Part D ID 2022 Creditability Matrix
Medicare Part D MT 2021 Creditability Matrix
Medicare Part D MT 2022 Creditability Matrix
Medicare Part D OR 2021 Creditability Matrix
Medicare Part D OR 2022 Creditability Matrix
Medicare Part D WA 2021 Creditability Matrix
Medicare Part D WA 2022 Creditability Matrix
Pharmacy Product Guidelines FAQ
Self-Funded Administrative Solutions