download forms for groups

Below are our most frequently requested forms in Acrobat PDF files. For other forms please contact us by email, call us at 800-400-1246 or go to the links page to access carrier websites.

Third Party authorization to Disclose Personal and Health Information

Select Carrier:

• Blue Shield of California
• Blue Cross of California
• HSA Bank
• Humana Dental
• Principal

• Blue Shield of California
  • Blue Shield of CA HIPAA Privacy Form
  • Blue Shield Life and Health
  • Employee Form for Health (2-50 size group)
  • Employee Form for Health (15+ size group)
  • Employee Change Form
  • Dental Enrollment Form (Dental only)
  • Medical Claim Form
  • Mail Order Pharmacy Drug Claim Form

• Blue Cross of California
  • Blue Cross HIPAA Privacy Form
  • Employee Application for a New Group(2-50)
  • New Hire Enrollment Form for Exisiting Group
  • Enrollment Form for Dental (only)
  • Employer Change Form
  • Monthly Group Enrollment Change Form
  • Medical Claim Form
  • Retail Pharmacy Drug Claim Form
  • Mail Order Pharmacy Drug Claim Form

• HSA Bank
  • Application
  • Beneficiary Form
  • Custodial Agreement

• Humana Dental
  • Enrollment Form for Dental
  • Employee Change Form

• Principal
  • Principal HIPAA Privacy Form

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