Affordable Care Act Notices
Enroll/Change/Term Forms
- All Insurers-Address Change Form (except Horizon small groups <50)
- Aetna AFA Enroll/Change Form
- Aetna NJ Dental/Life/Disabilty Enroll/Change Form
- Aetna NY Medical/Dental Enroll/Change Form
- Aetna PA Medical/Dental Enroll/Change/Waive Form
- AIG Enrollment Form
- AIG Evidence of Insurability Form
- AmeriHealth Administrator Portal Access
- AmeriHealth Enroll/Change Form
- AmeriHealth Guest Advantage
- AmeriHealth Overage Dependent
- AmeriHealth Term/Change Form
- AmeriHealth Medical Waiver
- Delta Dental Enroll/Change/Term
- Delta Dental Enroll/Change/Term Small Group (2-50)
- Delta Dental Student Verification Form
- Guardian Beneficiary Change Form
- Guardian Enroll/Chg/Term (dental only)
- Guardian Enroll/Chg/Term (multiple lines)
- Guardian EOI Form
- Guardian Student Verification Form
- Guard-O-Matic
- Hartford Beneficiary Form
- Hartford Enroll
- Hartford Change Form (employer use only)
- Hartford Term (employer use only)
- Hartford Notice of Conversion Rights
- Horizon BCBS NJ 51+ Enroll/Chg/Term
- Horizon BCBS NJ SG Med/Dent Enroll/Chg/Term
- Horizon BCBS NJ SG Medical Waiver
- Horizon Away from Home App
- IBC Enroll/Change/Term
- IBC/Keystone Guest Enrollment Application
- IBC/Keystone Waiver
- IBC Employer Portal User Access Form
- Members Health Plan Enroll Form
- Members Health Plan Waiver
- MetLife Enroll/Change/Term
- Oxford Add/Chg/Term (all)
- Oxford NJ Enroll/Change Form
- Oxford NY Enroll/Change Form
- Oxford NJ Medical Waiver Form
- Oxford NJ Large Group Medical Waiver Form
- Oxford NY Medical Waiver Form
- Principal Employee Add/Change Form
- Principal Beneficiary Change Form
- Principal Statement of Health Form
- SunLife Enroll/Beneficiary Form
- SunLife Change/Term Form
- SunLife Beneficiary Change Form
- SunLife Conversion Form
- UHC Dental/Vision Enroll/Waive
- UHC Medical Enroll/Waive
- United Concordia Enroll/Chg/Term
- Unum Beneficiary Form
- Unum Life/AD&D Enroll Form
- USAble Beneficiary Form
- USAble EOI Form
- USAble Life/AD&D Enroll/Chg/Term
- USAble Vol Life/AD&D Enroll/Chg/Term
COBRA/Continuation Forms
Group Insurance Forms
- Aetna Sm Group (up to 50 employees)
- Aetna Mid-Market Forms (51 – 3,000)
- AmeriHealth Dental Claim form (United Concordia)
- Aetna Vision Claim Form
- American General (AIG)
- AmeriHealth NJ
- Cigna
- Davis Reimbursement Form
- Delta Dental Student Form
- Guardian STD Claim Form
- Delta Dental
- Future Scripts Non-Formulary Exception
- Future Scripts Mail Order Form
- Guardian
- Guardian Dependent Eligibility Form
- Guardian EOI Form
- Guardian Guard-O-Matic
- Hartford
- Horizon BCBS
- Independence Blue Cross/Keystone
- Members Health Plan
- MetLife
- Oxford NJ Small Group
- Oxford NY Small Group
- Principal Vision Claim NJ Form
- Reliance Standard
- Sun Life Financial
- United Concordia
- UnitedHealthcare Employer Forms
- Unum
- VSP
Group Letters/Renewal Form
- AmeriHealth Authorization + Portal letter
- AmeriHealth NJ Sm Group Certification
- AmeriHealth Group Term Letter
- Employee Term Letter Sample (NJ groups <20 employees)
- Employee Term Letter Sample (NY groups all sizes)
- Employee Term Letter Sample (PA groups <20 employees)
- Employee Term Letter Sample (NJ, PA 20+ employees)
- Guardian Letter
- Horizon NJ Small Employer Certification
- Horizon Large Group Certification
- Horizon Census
- Horizon Group Term Letter
- Oxford Certification
- Oxford Group Term Request
HR Forms
Medicare Forms
Quick Forms
Online Forms
Client Intake Form (for prospective group clients)
Reporting (for current group clients)