Small Business Applications

To know more, click on the following links:

1. California

• Group Health Plans

  • Anthem Blue Cross

    • 2-50 Small Group Employee Application

    • 2-50 Small Group Employer Application

    • 2-50 Small Group Employee Addition Application

    • Sole Proprietor, Partner, or Corporate Officer Statement

    • Affidavit of Domestic Partnership

    • Patient Claim Form

    • Small Group Change of Coverage Application

    • Small Group Required Information Checklist

    • Translators Statement

    • Small Group New Business Inquiry

    • Small Group Benefit Modification Inquiry

    • Small Group Employee Information Change Form

    • Ceridian FSA/COBRA Application

    • Ceridian FSA/COBRA Services Flier

    • Ceridian COBRA Proposal

    • HIPAA-compliant Authorization Form - Agent

    • HIPAA-compliant Authorization Form Instructions - Agent

    • HIPAA-compliant Authorization Form BCLife & Health - Agent (Spanish)

    • HIPAA-compliant Authorization Form Blue Cross of California - Agent (Spanish)

    • Employer Group HSA Initiation Form

    • Group Participant Enrollment Package HSA

    • Employer's Statement of Understanding HSA

    • Premium Only Plan Enrollment Form

  • HSA California

    • Employer Application

    • Employee Application

    • Employee Application (Spanish)

    • Employer Change Request

    • Employee Change Request

    • Employee Change Request (Spanish)

    • Employee Health Questionnaire

    • Domestic Partner Affidavit

    • Domestic Partner Affidavit (Spanish)

    • Disabled Dependent Certification

    • Full Time Student Verification

    • Common Ownership Statement

• Group Dental Plans

  • Aetna Dental

    • Employee Application

    • Employer Application

  • Anthem Blue Cross Dental

    • Small Group Dental Employee Application

    • 2-50 Small Group Employer Application

  • Blue Shield Dental

    • Health & Joint Dental Employer Application

    • Health & Joint Dental Employee Application

    • Dental Stand Alone Employer Application

    • Dental Stand Alone Employee Application

  • Delta Dental - Elan Trust

    • Employee Application

    • Declination of Dental Coverage

  • DeltaCare - Elan Trust

    • Employee Application

    • Declination of Dental Coverage

  • First Dental Health

    • Employer Application

  • Golden West

    • Small Group Employee Application

    • Small Group Employer Application

  • Kaiser Permanente Dental

    • Employee Enrollment Application

    • New Group Application

  • PacifiCare Dental

    • Dental Employee Enrollment Form

    • Dental Employer Enrollment Form

    • Employee Declination of Coverage Form

  • UnitedHealthcare Dental

    • Employer Application

    • Employee Application

    • Pacific Union Dental Employer Application

    • Pacific Union Dental Employee Application

• Group Vision Plans

  • Blue Shield Vision

    • Stand-Alone Group Vision Application

    • Employee Vision Enrollment Form

  • UnitedHealthcare Vision

    • Employer Application

    • Employee Application

  • Vision Plan of America

    • Vision Employee Enrollment Form

    • Vision Employer Enrollment Form

    • Advantage Employee Enrollment Form

    • Advantage Employer Enrollment Form

  • Vision Service Plan

    • Employer Application

    • Employee Application

• Group Life Plans

  • Aetna Life

    • Employee Application

    • Employer Application

  • Blue Shield Life

    • Stand-Alone Group Life Application

    • Employee Life Enrollment Form

1. Illinois

• Group Health Plans

  • UniCare

    • Small Group Employee Application

    • Small Group Employer Application

    • Employer Statement of Understanding

1. Nevada

• Group Dental Plans

  • Freedom Dental

    • Employer Application

    • Employee Application

1. Texas

• Group Health Plans

  • UniCare

    • Small Group Employee Application

    • Small Group Employer Application

    • Consumer Choice Disclosure Notice

1. Virginia

• Group Health Plans

  • UniCare

    • Small Group Employee Application

    • Small Group Employer Application