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.
2021 ID Large Group Master Application (Medical/Dental)
2021 ID Small Group Master Application (Medical/Dental)
2021 MT Large Group Master Application (Medical/Dental)
2021 MT Small Group Master Application (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)
Attestation of Eligibility
Authorization to Use/Disclose Protected Health Information
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 - WA
Group Authorization Agreement for Recurring Electronic Fund Transfers (EFT)
Group Coverage Continuation Election Form (WA small group)
Group Identification Form - MT, OR, WA
Renewal Confirmation Form
RightFit Plan and PCP Selection Form (Washington only)
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 2021 Creditability Matrix
Pharmacy Product Guidelines FAQ
Self-Funded Administrative Solutions