Employer Forms

Below is a list of forms for employer groups that are available to the public. Additional forms may be available to you after you sign in to Employer Connection.

• Benefit Materials Consent Form
• Change Form
• COBRA Election Form
• Common Law Marriage
• Concern Form
• Coordination of Benefits (COB) Form
• Enrollment Form for 26+ Eligible Employees
• Enrollment Form for 2-25 Eligible Employees
• HIPAA PHI Form
• Individual Conversion Plan Procedure
• Individual Conversion Request Form
• Request for Dependent Coverage Due to Incapacitation
• Transition Form