Large Group Resources & Forms

Helping You Manage Your Account

Large group plan administrators may access the administrative forms, member forms and plan documents you need below. Get answers to your frequently asked questions.

Forms & Resources

• Administrative Quick Guide
• Enrollment Application & Termination Request Form 
• Master Group Application
• Renewal change form

Member Forms

• Authorized Representative Form
• Medical Reimbursement Claim Form
• Prescription Reimbursement Claim Form
• Coordination of Benefits Form
• Disabled Dependent Certification Form
• Medication Exception Form
• Appeal Request Form
• Member Request for Health Plan Records Form