Carrier Forms
Blue Cross
BCBS Enrollment Change Request Form 2-50
BCBS Employee Enrollment Application 2-50
BCBS Enrollment Change Request Form 51-150
BCBS Employee Enrollment Application 51-150
BCBS Employee Change Request Form 151+
BCBS Employee Enrollment Application 151+
Humana Employee Enrollment 51-99
Humana Employee Enrollment 100+
Spanish Humana Employee Enrollment 2-50
Spanish Humana Employee Enrollment 51-99
Spanish Humana Employee Enrollment 100+
UHC New Groups Master Application 2-25 Employees
UHC New Groups Employee Enrollment Form 2-25 Employees
UHC Spanish Employee Enrollment form 2-25 Employees
UHC New Groups Master Application 26-50 Employees
UHC New Groups Employee Enrollment Form 26-50 Employees
UHC Spanish Employee Enrollment Form 26-50 Employees
UHC Illinois Authorization Waiver Form
UHC Existing Group New Hire Employee Enrollment Form 2-25 Employees
UHC Existing Group New Hire Employee Enrollment Form 26-50 Employees
UHC Spanish Existing Group New Hire Employee Enrollment Form
Assurant (Fortis)
Assurant Request for Administrative Supplies
Assurant Change Form
Assurant HIPAA Authorization for Release of Protected Health Information Form
Assurant Authorization for Release of Records
Assurant Dental Claim Statement
Assurant Group Life and AD&D Claim Form - Employee Life Form #KC2176G
Assurant Group Life and AD&D Claim Form - Employee Life-Form #KC2176H
Assurant Group Life and AD&D Claim Form - Accidental Death Form #KC2176G
Assurant Group Life and AD&D Claim Form - Accidental Death Form #KC2176H
Assurant Group Life and AD&D Claim Form - Dependent Life Form #KC2176G
Assurant Group Life and AD&D Claim Form - Dependent Life Form #KC2176A
Assurant Dental Employee Application
Assurant Disability - Long Term Disability Claim Form
Assurant Disability - Long Term Disability Claim Form Addendum
Assurant Disability - Short Term Disability Claim Form
Assurant COBRA DENTAL - Request to Elect Dental COBRA Form
Carrier Forms