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Illinois Agents Forms & Resources: Large Groups

Enrollment Forms

New Large Group Checklist

Large Group Census Template

Employer Group Application (EGA)

Employee Application – with medical questions
(use when claims experience isn’t available)

Employee Application – no medical questions
(use when claims experience is available)

New Hire Application/Employee Change form

Domestic Partner Affidavit

Parent & Stepparent Affidavit

Additional Forms

CMS Survey

COBRA Group Continuation Notice

Creditable Coverage – 2026 | 2025 – Learn More

Group Autopay Form