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Illinois Agents Forms & Resources: Large Groups

Form Type

New Large Group Forms

New Group Checklist

Employer Group Application 

Employee Application
(use with claims experience)

Employee Application 
(use when no claims experience)

Domestic Partner Affidavit 

Existing Large Group Forms

CMS Survey

New Hire application/Employee change form

Employer Group Application

Creditable Coverage – 2025 | 2024 – Learn More

Waiver of Coverage

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