Small Group Forms
- 2023 New Group Enrollment Checklist
- 2023 Master Application Benefit Selections
- 2023 Small Group Master Application
- 2022 Washington Small Group Quote Assumption
- 2023 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
- Kinwell Health
Member Enrollment and Other Forms
- 2023 Member Enrollment And Change Application
- Member Enrollment and Change Application (Spanish version)
- 2023 Member Enrollment and Change Application (Spanish)
- 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