Enrollment Forms | Additional Forms |
| Employer Application – 2021 | 2020 | Large Group Creditable Coverage – 2021 | 2020 | Learn More |
| Employee Application (use when no claims experience) – 2021 | 2020 | Renewability and Rating Notice |
| Employee Questionnaire – 2021 | 2020 | |
| Employee Census Template | |
| CMS Survey | |
| Waiver of Coverage Form – 2021 | 2020 | |
| Domestic Partner Affidavit – 2021 | 2020 |
New Small Group Forms | Existing Group Forms |
| Illinois Small Group Employee Application/Change Form – 2021 | 2020 | Illinois CMS Survey |
| Illinois Small Group ACA Plans 2020 | COBRA Group Continuation Notice |
| Employee Census Template | Illinois Employer Group Application |
| Illinois Small Group Creditable Coverage – 2021 | Learn More | |
| Quartz Drug Formulary: $0 Copay List | |
| Quartz Drug Formulary: Rx Outcomes List | |
| Quartz High-Deductible Health Plan $0 Safe Harbor Drug List | |
| Renewability and Rating Notice |
| Individual Application | Plan Options |
| English - 2021 | Quartz One - Standard Plan | CSR Plan |
| Spanish - 2021 | |
| Domestic Partner Affidavit |
