Small Business Forms

Download application forms for employer and employee group health, dental, vision and life plans from a variety of providers, as well as change request forms and more.

Group Health Plans

• Aetna
  • Employee Application
  • Employer Application
  • Proof of Eligibility
  • Declaration Of Domestic Partnership
  • 1099 Eligibility Verification Form
• Anthem Blue Cross
  • 2-50 Small Group Employee Application
  • 2-50 Small Group Employer Application
  • 2-50 Small Group Employee Addition Application
  • Sole Proprietor, Partner, or Corporate Officer Statement
  • Affidavit of Domestic Partnership
  • Patient Claim Form
  • Small Group Change of Coverage Application
  • Small Group Required Information Checklist
  • Translators Statement
  • Small Group New Business Inquiry
  • Small Group Benefit Modification Inquiry
  • Small Group Employee Information Change Form
  • Ceridian FSA/COBRA Application
  • Ceridian FSA/COBRA Services Flier
  • Ceridian COBRA Proposal
  • HIPAA-compliant Authorization Form - Agent
  • HIPAA-compliant Authorization Form Instructions - Agent
  • HIPAA-compliant Authorization Form BCLife & Health - Agent (Spanish)
  • HIPAA-compliant Authorization Form Blue Cross of California - Agent (Spanish)
  • Employer Group HSA Initiation Form
  • Group Participant Enrollment Package HSA
  • Employer's Statement of Understanding HSA
  • Premium Only Plan Enrollment Form
  • EE Medical Plan Change Request Form
• Anthem Blue Cross BeneFits
  • 2-50 Small Group Employee Application
  • 2-50 Small Group Employer Application
• Blue Shield
  • Master Group Application
  • Employee Application
  • Refusal of Personal Coverage
  • Change Request Form
  • Employee Questionnaire (2-14)
  • Employer Questionnaire (15-50)
  • Sole Proprietor, Partner, or Corporate Officer Statement
  • Statement of Domestic Partnership
  • Conversion to Individual Coverage Form
  • Subscriber Disability Form
  • Eligibility Change Form
  • Subscribers Statement of Claim
  • COBRA Application
  • Cal COBRA Takeover Form
  • Cal COBRA Employer Notification Form
  • Direct Reimbursement Claim
  • Full Time Student Certification
  • International Claim Form
  • Group Change Request Form
  • Verification and Statement of Understanding
• California Choice
  • Employer Application
  • Employee Application
  • Employee Application (Spanish)
  • Salud Application
  • Employer Change Request
  • Employee Change Form
  • Employee Change Request (Spanish)
  • Employee Renewal Change Request Form
  • Employee Health Questionnaire
  • Domestic Partner Affidavit
  • Domestic Partner Affidavit (Spanish)
  • Disabled Dependent Certification
  • Student Verification
  • Owner/Partner Statement
• Cigna
  • Employer Application
  • Group Enrollment/Change Form
  • Group Membership Application & Guidelines
  • Declination of Medical/Dental Coverage Form
  • Sole Proprietor
  • Health Statement
  • Health Insurance Claim Form
  • Group Dental Claim Form
  • International Medical and Dental Claim Form
  • Underwriting Checklist
• Health Net
  • Small Business Plans Group Service Agreement
  • Small Business Employee Enrollment Form
  • Small Business Group Enrollment Form - Spanish
  • Affidavit of Domestic Partnership
  • Health Questionnaire
  • Health Questionnaire (Spanish)
• Health Net HnOptions
  • Employer Application
  • Employee Application
• HSA California
  • Employer Application
  • Employee Application
  • Employee Application (Spanish)
  • Employer Change Request
  • Employee Change Request
  • Employee Change Request (Spanish)
  • Employee Health Questionnaire
  • Domestic Partner Affidavit
  • Domestic Partner Affidavit (Spanish)
  • Disabled Dependent Certification
  • Full Time Student Verification
  • Common Ownership Statement
• Kaiser Permanente
  • Employee Enrollment Application
  • New Group Application
  • Student Certification
  • Domestic Partner Affidavit
  • Employee Enrollment Application (Spanish)
  • Declination of Coverage
  • COBRA Enrollment Form
  • COBRA Information Sheet
  • Proprietor Partnership Form
  • Account Change Form
  • Termination and Transfer Form
• Kaiser Permanente Choice Solution
  • Employer Application
  • Employee Application
  • Employee Health Questionnaire
  • Owner/Partner Statement
  • Cobra Enrollment
  • Change Request Form
  • Cobra Billing Direct
  • Underwriting Guidelines
• PacifiCare
  • Prescription Mail Order
  • Employee Enrollment and Declination of Coverage Form
  • Group Acceptance/Change Form (GAF)
  • Change Request Form
  • COBRA Election Form
  • Cal-COBRA Election Form
  • Cal-COBRA Event Form
  • POS Medical Claim Form
  • Small Group Employer Application and Questionnaire
  • Small Business Individual Health Statement Application
  • Proprietor Statement
  • Self Directed Health Plan Claim Form
  • Employer Group Reporting Form
  • PPO-Indemnity Medical Claim Form
  • Student Status
  • Declination of Coverage
  • Domestic Partnership
  • HIPAA Member Authorization
  • Spanish Employer Application
  • Spanish Employee Enrollroment
  • Spanish Employee Change Request
  • Spanish Employer Cobra Election Form
  • Spanish Health Statement
• Sharp
  • Employer Application
  • Employee Application
  • Employee Application-Spanish
  • Declination of Coverage Form
  • Employee Medical Questionnaire
  • Corporate Officer Statement
  • Declaration of Domestic Partnership
  • Employer's Group Submission Checklist
• UnitedHealthcare
  • Employer Application
  • Employee Application
  • Group Acceptance/Change Form
  • Individual Health Statement
  • Product and Benefit Selection Form
• Western Health
  • Employer Group Application
  • Enrollment/Change Form
  • Domestic Partner Form
  • Electronic Funds Transfer Agreement
  • Health Statement
  • Proprietor and Partnership Form
  • Waiver of Coverage
  • Termination Form

Back To Top | Dental | Back Home

Group Dental Plans

• Aetna Dental
  • Employee Application
  • Employer Application
• Anthem Blue Cross Dental
  • Small Group Dental Employee Application
  • 2-50 Small Group Employer Application
• Blue Shield Dental
  • Health & Joint Dental Employer Application
  • Health & Joint Dental Employee Application
  • Dental Stand Alone Employer Application
  • Dental Stand Alone Employee Application
• Delta Dental
  • Employer Application North
  • Employer Application South
  • Employee Application
  • Declination of Dental Coverage
• Delta Dental - Elan Trust
  • Employee Application
  • Declination of Dental Coverage
• DeltaCare - Elan Trust
  • Employee Application
  • Declination of Dental Coverage
• First Dental Health
  • Employer Application
• Golden West
  • Small Group Employee Application
  • Small Group Employer Application
• Kaiser Permanente Dental
  • Employee Enrollment Application
  • New Group Application
• PacifiCare Dental
  • Dental Employee Enrollment Form
  • Dental Employer Enrollment Form
  • Employee Declination of Coverage Form
• UnitedHealthcare Dental
  • Employer Application
  • Employee Application
  • Pacific Union Dental Employer Application
  • Pacific Union Dental Employee Application

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Group Vision Plans

• Blue Shield Vision
  • Stand-Alone Group Vision Application
  • Employee Vision Enrollment Form
• PacifiCare Vision
  • Vision Employee Enrollment Form
  • Vision Employer Enrollment Form
• SafeGuard Vision
  • Vision Employee Enrollment Form
  • Vision Employer Enrollment Form
• UnitedHealthcare Vision
  • Employer Application
  • Employee Application
• Vision Plan of America
  • Vision Employee Enrollment Form
  • Vision Employer Enrollment Form
  • Advantage Employee Enrollment Form
  • Advantage Employer Enrollment Form
• Vision Service Plan
  • Employer Application
  • Employee Application

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Group Life Plans

• Aetna Life
  • Employee Application
  • Employer Application
• Blue Shield Life
  • Stand-Alone Group Life Application
  • Employee Life Enrollment Form

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