Group Medical Products and Forms

We do our best to maintain this forms section for your convenience. If you can't find a form you need or find one you think is outdated, please notify us.

GET A QUOTE NOW

We offer a variety of carriers/plans.
Complete our easy-to-use quote form so we can provide you the quotes & plan designs that best fit your needs.

Group Quote Request Form

ONLINE SUBMISSION

FormFire is an electronic application process that streamlines the group benefits process from start to finish. We can offer you the FormFire platform for your MEWA and self-funded groups with NO monthly fees. Contact Mindy Van Order for details on how to take advantage of this service.

ACA Medical

Aetna

Contact us for more information on these group plans.

Aetna Insurance Website

Anthem BCBS

Anthem BCBS Website

Employer Group Enrollment App (2019)

Employee Enrollment App (ACA)

2019 SG Broker Product Guide

Employee Change Form (ACA)

Checklist

Medical Mutual of Ohio

Contact us for more information on these group plans.

Summary of Benefit Coverages

Application EE 2-50 OFF (R10/17)

Application ER 2+ OFF (R10/17)

Checklist (R9/17)

Contract (R4/16)

United Healthcare

Contact us for more information on these group plans.

App EE (group 2-9)

App EE (group 10-50)

App EE (group 50-99) 290-4399 10/10

GAP

Beazley

Application, Change or Term EE (12/11/15)

Brochure (7/30/15)

IHC

IHC Website

Morgan White - Premium Saver

Brochure

FAQ (7/15)

Checklist

Meet the Premium Saver Plan (video)

Employee Application

Employer Application

Legacy (preACA)

Anthem BCBS

Anthem Website

Application EE (grp 2-50) (Rev 11/14)

Employee Change Form (Legacy)

Termination/PCP Change Form (8/11) for both pre-ACA and ACA

Medical Mutual of Ohio

Application-change form 1-19 Z6115 (R10/14)

MEWA

Multiple Employer Welfare Arrangement (MEWA) plans can be offered to groups from 2-50 enrolled.  These self-funded plans can be a good fit for your small group clients for many reasons including:

  • Competitive rates based on the health of the group.
  • Predictable, fixed monthly payments.
  • Protection of being part of a larger self-funded pool backed with stop loss coverage.
  • Flexibility in choice of benefit plans.

Carrier certification and FormFire training is required before you are able to sell these plans. Contact Scott Lewis for more information on these group plans.

Self-Funded

Aetna - AFA

Contact us for more information on these group plans.

Aetna Website

Allied National

Allied National Website

Brochure (2016)

Application EE (12/15/15)

New Case Transmittal Form (2016)

Waiver form EE (12/15/15)

Prescreen vs. Submission (2016)

Application ER (12/15/15)

HealtheChoices

HealtheChoices Website

National General

Application Kit (9/1/15)

Brochure (2/6/18)

Underwriting guide (1/8/16)

Starmark (Trustmark)

Starmark (Trustmark) Website

Application EE under 50 12/16

Application EE 50+ 12/16

Application ER 1/16

Termination/Waiver 3/07

51+ Groups

We are happy to help you with your 51+ groups. Because of the complexity of plans, we are unable to provide direct carrier links. Please contact Scott Lewis for more information on 51+ groups.