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AMERIHEALTH
Individuals
- 2023 IHC Application
- 2022 IHC Application
- 2021 IHC App with Payment Info
- Davis Vision Reimbursement Claim Form
- HIPAA Authorization for Disclosure of Health Info
- Out of Pocket Maximum Reimbursement Form
CIGNA
2-50
DELTA-DENTAL
2-50
HORIZON
Individuals
- 2023 IHC app for child only policy
- 2023 IHC Spanish enrollment form
- 2023 IHC app- Spanish
- 2023 IHC app
- 2023 IHC BOR
- 2023 IHC Dental & Vision App- Spanish
- 2023 IHC Dental & Vision App
- 2022 IHC Application-Dental/Vision
- 2022 IHC Termination Form
- Individual Term Form
- Away from Home Care Services Application
- Spanish Version: Special Enrollment Documentation Requirements
51+
- Midsize/Large group enrollment form
- 51+ Master Application
- Spanish Version: Midsize Enrollment Form
- Horizon Large Group Certification
2-50
- 2023 SEH Master Application
- 2023 SHOP Master Application
- Level Select Master App
- 2022 SEH Master App
- 2022 SHOP Master App
- HSA Funding Form
- NEW HSA Setup Form effective 1/1/19
- Declaration of Understanding *New June 2021*
- Spanish Version: Waiver of Coverage
- Spanish Version: New Group Application
- Highlighted Small Group Enrollment/Change Request
- Small Employer Common Ownership Certification
- Auto Pay Application
- Small Group Enrollment/ Change Request
- Small Employer Certification
- Small Employer Waiver
- 2-5 Form
- Away From Home Care Services Application
- Conversion Request Form
2-50 & 51+
Individuals, 2-50 & 51+
Individuals & 2-50
HORIZON-ANCI
2-50
- AXA Member Enrollment Form
- AXA Member Enrollment Form w/Disability
- Davis Vision claim form
- Bundle New Business Paperwork *New USAble app eff. 10/1/21*
- Horizon Dental Waiver
- Small Employer Vision Group Application
- Small Employer Dental Group Application
Individuals
METLIFE
Individuals
- Statement of Responsibility
- Metlife Binder Check Cover Form
- Group Submission Disclosure Form
- eCensus Format
MIG
2-50 & 51+
NIPPON
51+
OSCAR
2-50
- 2021 Master Application
- 2021 Employee Application
- 2021 Waiver
- 2021 Certification
- Small Group EFT form
Individuals
OXFORD
2-50
- HSA Certificate of Understanding
- 2023 Master Application
- OXLF Enrollment form with MUW
- EE Enrollment Form
- 2022 OHI Master App
- 2022 OHP Master App
- Group Contact/Address/Name Change Form
- Waiver
- 2021 Certification
- Oxford Verification Form
- Common Ownership Form for Affiliated Groups
51+
2-50 & 51+
Individuals, 2-50 & 51+
Individuals
- Health Insurance Claim Form
- HIPAA Member Authorization
- Prescription Drug Reimbursement Claim Form
- OptumRx Authorization Form
OXFORD-ANCI
2-50
- OBM Master Application
- UHC Dental & Vision Enrollment Application
- UHC Dental & Vision Master Application
- OBM Small Group Checklist
- OBM dental/vision employee application
PRINCIPAL
2-50
USABLE