Forms

• Affidavit of Domestic Partnership Legally establish a domestic partnership for the purposes of enrolling your partner on your health insurance plan.
• Disability Certification Form Certification of an unmarried child's disability and eligibility for continued coverage.
• Termination Request Form All subscriber terminations must be written on this form to be processed properly.

• How to Complete Plan Sponsor Certification of Group Health Plan HIPAA
• HIPAA Form 2(I) Plan Sponsor Certification of Group Health Plan HIPAA Compliance and Authorization for Third Party Access to PHI Completion of this form confirms Plan Sponsor’s compliance with applicable HIPAA requirements and identifies third parties authorized to receive PHI on behalf of the Plan Sponsor

• Large Group Enrollment Application/Change Form
• Small Group Enrollment Application/Change Form