Small Group Forms
- New Group Enrollment Checklist 2022
- Master Application Benefit Selections
- Small Group Master Application
- 2022 Washington Small Group Quote Assumption
- 2022 Dental Benefit Selection
- Group Size Attestation
- Personal Funding Account Setup - for metallic groups
- Electronic Funding Authorization (HSA)
- Late Enrollment Acknowledgment
- Quick Reference Guide for Plan Administrators
- Key Employee Verification
- Vivacity Care Center
Member Enrollment and Other Forms
- 2022 Member Enrollment and Change Application
- Member Enrollment and Change Application (Spanish version)
- Affidavit of Domestic Partnership Group Plans
- Deductible Credit Form
- Enrollment Spreadsheet (in lieu of member enrollment applications)
- Other Coverage Questionnaire Enrollment
- Personal Funding Accounts Enrollment and Change Application
- Request for Certification of Disabled Dependent
- Waiver of Coverage
- Transition of Care Form