Employer documents & forms

Commonly used forms

Cancel form for employees or dependents

COBRA Forms

Electronic funds transfer form

Employer portal access request form

Employer portal access request form — Small group

Group plan enrollment/waiver form — 2025

Small group change form

Administer your company’s health benefits with these forms and benefit administration guides.

2025

2025 Small group business application - Opens in a new window - Opens PDF in a new window

2025 Enrollment/waiver form — English - Opens in a new window - Opens PDF in a new window

2025 Enrollment/waiver form — Spanish - Opens in a new window - Opens PDF in a new window

2024

2024 Small group business application - Opens in a new window - Opens PDF in a new window

2024 Enrollment/waiver form — English - Opens in a new window - Opens PDF in a new window

2024 Enrollment/waiver form — Spanish - Opens in a new window - Opens PDF in a new window

General

Authorization for disclosure of health information — Online form

Authorization for disclosure of health information — English PDF - Opens in a new window - Opens PDF in a new window

Authorization for disclosure of health information — Hmong PDF - Opens in a new window - Opens PDF in a new window

Authorization for disclosure of health information — Spanish PDF - Opens in a new window - Opens PDF in a new window

Cancel form for employees or dependents - Opens in a new window - Opens PDF in a new window

Small group change form - Opens in a new window - Opens PDF in a new window

HIPAA special enrollment notice - Opens in a new window - Opens PDF in a new window

Subscriber claim form - Opens in a new window - Opens PDF in a new window

Large group HIPAA special enrollment notice - Opens in a new window - Opens PDF in a new window

2025 Enrollment/waiver form — English - Opens in a new window - Opens PDF in a new window

2025 Enrollment/waiver form — Spanish - Opens in a new window - Opens PDF in a new window

Large group cancelation form — English - Opens in a new window - Opens PDF in a new window

Large group cancelation form — Spanish - Opens in a new window - Opens PDF in a new window

Medicare Part D creditable letter - Opens in a new window - Opens PDF in a new window

Medicare Part D non-creditable letter - Opens in a new window - Opens PDF in a new window

COBRA Forms and information - Opens in a new window

Authorization for disclosure of health information — Online form

Authorization for disclosure of health information — English PDF - Opens in a new window - Opens PDF in a new window

Authorization for disclosure of health information — Hmong PDF - Opens in a new window - Opens PDF in a new window

Authorization for disclosure of health information — Spanish PDF - Opens in a new window - Opens PDF in a new window

Fully insured plan election form (2024) - Opens in a new window - Opens PDF in a new window

Fully insured plan election form (2025) - Opens in a new window - Opens PDF in a new window

Self-insured plan election form (2024) - Opens in a new window - Opens PDF in a new window

Self-insured plan election form (2025) - Opens in a new window - Opens PDF in a new window

Retiree-only group attestation form (2024) - Opens in a new window - Opens PDF in a new window

Retiree-only group attestation form (2025) - Opens in a new window - Opens PDF in a new window

Grandfathered plan notice - Opens in a new window - Opens PDF in a new window

MA HCR filing service - Opens in a new window - Opens PDF in a new window

Premium contribution tool (XLS) - Opens in a new window

Only for fully insured groups, to determine grandfathered status

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Employer reporting solution guide

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Employer reporting solution guide