Agents

New Large Group Forms

Employer Group Application

Employee Application Form — English  |  Spanish
(Use when no claims experience)

Employee Application Form — English  |  Spanish
(Use with claims experience)

New Group Checklist – Large Group Submitting Experience Data

New Group Checklist – Large Group Submitting Health Applications

Large Group Census Template

Creditable Coverage – 2022 | 2023 Learn More

Existing Large Group Forms

Employee Application for New Hire

Waiver of Coverage Form — English  |  Spanish

COBRA Group Continuation Notice