Our employee and employer applications are newly revised. Download the current versions for both small and large groups by state. Please remember, if an employee checks that they are married and the spouse isn't listed as a dependent on the application, then the waiver on the application needs to be signed for the spouse.
Note: Old applications will only be accepted until November 30, 2019.
Agent “Bat Phone” – Help is Standing By
Did you know Quartz has a phone line separate from our normal Customer Service lines just for agent questions related to group enrollment or premium billing?
Call our dedicated agent line at (800) 362-3310 Ext. 101825 for help with –
- Invoice Questions
- Premium Rates
- Probation Periods
- When Group ID Cards were mailed
- Group Demographic Changes
Learn more about our Agent Line.
Primary Care Providers vs. Primary Care Clinics
In the past, Quartz has required our members to select a primary care provider (PCP), which would show on their ID card. Now we are asking members to name a primary care clinic (PCC). Members who don’t make a selection will be assigned to a clinic near their home, and the clinic name will appear on their ID card as their PCC.
As a reminder, if you are submitting an Agent of Record (AOR) request, please make sure –
- The letter is written on group’s company letterhead
- The letter is signed by a representative of the group and is legible
- The group clearly states that they want a new agent to represent their health insurance
- The agent and agency names being requested are identified
Also, specify the Quartz group policy number. If the Group has more than one group number make sure to capture all group numbers (e.g., HSA, dual-option plans, COBRA, etc.). Thank you!
Employers must notify Quartz of terminations within 60 days of the event for policy / premium adjustments. Please reconcile your invoice monthly and report any changes to Quartz immediately.