Application & Forms

• 2026 Small Group Packet
• Multi-User Employer Connection Security Request Form
• Small Group Enrollment and Change Form

Steps for completing your application and forms:

1. Open the file
2. Download and Save to your Computer
3. Fill-out the form
4. Save it
5. Send us the forms

Please contact an Account Executive if you have questions or need assistance in completing the forms.

Contact Us Today!

Phone:

(918) 594-5294

Request for Proposal Email:

RFP@ccok.com

Step 1: Complete the Employer Group Application

In addition to knowing what plans you are interested in offering to your employees, you will need additional information to apply. To start your application, please have the following information ready:

• Personal information about your Employer group including tax identification number.
• Think about how you need your billing statement to reflect any different locations
• What is your current hourly requirement to be eligible for benefits? How many employees are currently on your payroll? How many are full time employees? How many employees will be enrolling in coverage?
• What is your current waiting period before an employee can enroll in your medical plan? You can decide how much time must pass before coverage can become effective for a new employee that is hired outside of your enrollment/renewal period. However, regulations state that the waiting period can not be more than 90 days. The most common waiting periods are first of the month following 30 or 60 days, immediately following 30, 60, or 90 days, or first of the month following hire date.
• What is your current employer contribution requirement?
• Do you have qualified group dental coverage? Please see the dental attestation form which will need to be included.
• Do you know about the Insure Oklahoma premium reimbursement program? You could qualify. Please visit http://www.insureoklahoma.org/ for more information. If you qualify, please make sure you are enrolling with a qualified CommunityCare plan.
• Please be prepared to include information about your brokers

STEP 2: Enroll your employees.

See the employee application below. This is the information that will either need to be input into a secure portal or submitted to CommunityCare via paper applications. CommunityCare will need an enrollment form for each of the employee’s on your payroll that is eligible for benefits even if they are electing to waive the offered coverage.

• Small Group Enrollment and Change Form