Documents & Forms
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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 Individual and Family Policy Enrollment Form (Medical and Dental)
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 Individual and Family Policy Enrollment Form (Medical and 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 Individual and Family Policy Enrollment Form (Medical and Dental)
2021 OR Large Group Master Application (Medical/Dental)
2021 OR Small Group Master Application (Medical/Dental)
2021 WA Individual and Family Policy Enrollment Form
2021 WA Large Group Master Application (medical)
2021 WA Small Group Master Application (medical)
Common Ownership Form
Coordination of Benefits
Employer Exemption Certification for Religious or Moral Objections
Group Coverage Continuation Election Form (WA small group)
Group Identification Form
ID Universal Application (Mid-size Group 51-99)
Large Group Census - ID (CURV)
Large Group Census - MT
Large Group Request for Quote (census form) - WA
Prospective Agent Appointment Form
Quote Request for Small Groups
Renewal Confirmation Form
RightFit Plan and PCP Selection Form (Washington only)
Short Form Health Statement (required if no claims experience submitted)
Split Carrier Waiver of Coverage
Washington Proposal Request: Fully Insured (Large Group 51-99)
2020 ID Individual and Family Brochure
2020 ID Individual and Family Dental Only Plan Comparison
2020 ID Individual and Family Medical Plan Comparison
2020 ID Individual and Family Plan Rates
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 ID Small Group Dental Only Plan Comparison
2020 ID Small Group Medical Plan Comparison
2020 MT Individual and Family Brochure
2020 MT Individual and Family Brochure - Dental Only
2020 MT Individual and Family Medical Plan Comparison
2020 MT Individual and Family Plan Rates
2020 MT Large Group Brochure
2020 MT Large Group Brochure - Dental Only
2020 MT Small Group Brochure
2020 MT Small Group Dental Only Plan Comparison
2020 MT Small Group Medical Plan Comparison
2020 OR Individual and Family Brochure
2020 OR Individual and Family Brochure (Navigator only)
2020 OR Individual and Family Dental Only Plan Comparison
2020 OR Individual and Family Medical Plan Comparison
2020 OR Individual and Family Medical Plan Comparison (Navigator only)
2020 OR Individual and Family Plan Rates
2020 OR Large Group Brochure
2020 OR Large Group Brochure (Dental Only)
2020 OR Small Group Brochure
2020 OR Small Group Dental Only Plan Comparison
2020 OR Small Group Medical Plan Comparison
2020 WA Individual and Family Plan Comparison
2020 WA Large Group Brochure
2020 WA Small Group Brochure
2020 WA Small Group Medical Plan Comparison
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
Expanded No-cost Drug List
Large Group ID Self-Funded Dental Flier
Large Group MT Self-Funded Dental Flier
Large Group OR Self-Funded Dental Flier
Pharmacy Product Guidelines FAQ
Self-Funded Administrative Solutions
Value Based Preventive Drug List