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 into the Employer Connection portal on CareWeb.

• Change Form
• COBRA Election Form
• Common Law Marriage
• Coordination of Benefits (COB) Form
• Employer Billing Key Code
• Employer Connection Security Request Form
• Small Group Enrollment Form
• Large Group Enrollment Form
• Protected Health Information (PHI) Authorization Form
• Request for Dependent Coverage Due to Incapacitation