Enrollment Material

• Enrollment checklist
• 2016 Small Group Plan Comparison 
• GA Change Form
• GA Block Transfer Spreadsheet

Quote Request Forms

• How to Submit a Quote Request 
• S4 Census Template
• S4 Customer Profile Form
• Enrollment Spreadsheet (in lieu of enrollment applications)

Group / Employer Forms

• Group Master Application up to 50 Employees
• Group Master Application Benefit Selection
• Group Master Application Dental Benefit Selection 
• Group Late Acknowledge Form
• Group Verification of Medicare

HSA / HRA Employer Forms

• HSA/HRA Group Funding Account Setup
• How-to Guide: Funding HSA Accounts
• Group Electronic Funding Authorization 
• Business Associate Agreement of ERISA Groups (HRA)
• Business Associate Agreement of non-ERISA Groups (HRA) 

Subscriber / Employee Forms

• Employee Enrollment & Change Form
• Employee Waiver of Coverage Form
• Employee Other Coverage Questionnaire
• Prescription Drug Reimbursement Form
• Deductible Credit Form
• Key Employee Verification Form 

HSA / HRA Employee Forms

• Employee Personal Funding Account Enrollment & Change Form
• UMB Transfer Form
• UMB HSA Account closure/Withdrawal Form
• UMB Beneficiary Designation Form 

Wellness

• S4 On-Site Wellness
• Wellness Program Employer Flyer
• Wellness Program Employer Brochure
• Member Flyer
• Wellness Plan Member Guide
• Biometric FAQ

Washington National - Worksite Benefits

• Critical Solutions Brochure
• Accident Assure WS Brochure
• Worksite Case Management
• Life Assure Brochure