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
Common Ownership Form
Coordination of Benefits
Employer Exemption Certification for Religious or Moral Objections - WA
Group Coverage Continuation Election Form (WA small group)
Group Identification Form - MT, OR, WA
Large Group Census - ID (CURV)
Large Group Census - MT
Large Group Request for Quote (census form) - WA
Proposal Request: Fully Insured (Large Group 51-99) - WA
Proposal Request: Fully-Insured (Large Group 51-99) - ID
Prospective Agent Appointment Form
Quote Request for Small Groups
Renewal Confirmation Form
Request for Quote Large Group (51+) - MT
Short Form Health Statement (required if no claims experience submitted) - MT
Split Carrier Waiver of Coverage
Universal Application (Mid-size Group 51-99) - ID
2023 MT Large Group Brochure - Dental Only
2022 ID Individual and Family Brochure - Navigator
2022 ID Individual and Family Brochure - Voyager
2022 ID Individual and Family Dental Only Plan Comparison
2022 ID Individual and Family Medical Plan Comparison - Navigator
2022 ID Individual and Family Medical Plan Comparison - Voyager
2022 ID Individual and Family Plan Rates (Navigator)
2022 ID Individual and Family Plan Rates (Voyager)
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 ID Small Group Dental Only Plan Comparison
2022 ID Small Group Medical Plan Comparison - Navigator
2022 ID Small Group Medical Plan Comparison - Voyager
2022 Idaho Individual Dental Exclusions
2022 Idaho Small Group Dental Exclusions
2022 MT Individual and Family Brochure - Navigator
2022 MT Individual and Family Dental Only Plan Comparison
2022 MT Individual and Family Medical Plan Comparison - Navigator
2022 MT Individual and Family Plan Rates
2022 MT Large Group Brochure
2022 MT Large Group Brochure - Dental Only
2022 MT Small Group Brochure - Navigator
2022 MT Small Group Dental Only Plan Comparison
2022 MT Small Group Medical Plan Comparison - Navigator
2022 OR Individual and Family Brochure - Navigator
2022 OR Individual and Family Dental Only Plan Comparison
2022 OR Individual and Family Errata for Medical Plan Comparison and Brochure
2022 OR Individual and Family Medical Plan Comparison - Navigator
2022 OR Individual and Family Plan Rates
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 OR Small Group Dental Only Plan Comparison
2022 OR Small Group Medical Plan Comparison - Navigator
2022 OR Small Group Medical Plan Comparison - Voyager
2022 WA Health Plan Disclosure
2022 WA Individual and Family Plan Rates
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
2022 WA Small Group Dental Only Plan Comparison
2022 WA Small Group Medical Plan Comparison - Navigator
2022 WA Small Group Medical Plan Comparison - Voyager
2023 ID Individual and Family Brochure - Navigator
2023 ID Individual and Family Brochure - Voyager
2023 ID Individual and Family Dental Only Plan Comparison
2023 ID Individual and Family Medical Plan Comparison - Navigator
2023 ID Individual and Family Medical Plan Comparison - Voyager
2023 ID Individual and Family Plan Rates (Navigator)
2023 ID Individual and Family Plan Rates (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 - Voyager
2023 ID Small Group Dental Only Plan Comparison
2023 ID Small Group Medical Plan Comparison - Navigator
2023 ID Small Group Medical Plan Comparison - Voyager
2023 Idaho Individual Dental Exclusions
2023 Idaho Small Group Dental Exclusions
2023 MT Individual and Family Brochure - Navigator
2023 MT Individual and Family Dental Only Plan Comparison
2023 MT Individual and Family Medical Plan Comparison - Navigator
2023 MT Individual and Family Plan Rates
2023 MT Large Group Brochure - Dental Only
2023 MT Large Group Brochure - Navigator
2023 MT Small Group Brochure - Navigator
2023 MT Small Group Dental Only Plan Comparison
2023 MT Small Group Medical Plan Comparison - Navigator
2023 OR Individual and Family Brochure - Navigator
2023 OR Individual and Family Dental Only Plan Comparison
2023 OR Individual and Family Medical Plan Comparison - Navigator
2023 OR Individual and Family Plan Rates
2023 OR Small Group Brochure - Navigator
2023 OR Small Group Brochure - Voyager
2023 OR Small Group Dental Only Plan Comparison
2023 OR Small Group Medical Plan Comparison - Navigator
2023 OR Small Group Medical Plan Comparison - Voyager
2023 WA Health Plan Disclosure
2023 WA Individual and Family Plan Rates
2023 WA Small Group Medical Plan Comparison - Navigator
2023 WA Small Group Medical Plan Comparison - Voyager
Balance Billing Protection Notice for ID
Balance Billing Protection Notice for MT
Balance Billing Protection Notice for OR
Balance Billing Protection Notice for WA
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
Large Group WA Self-Funded Dental Flier
Pharmacy Product Guidelines FAQ
Self-Funded Administrative Solutions
Value Based Preventive Drug List