Illinois Forms

Group Product Forms

Enrollment Forms

Additional Forms

Employer Application – 2019 | 2020Quartz Drug Formulary: $0 Copay List
Employee Application Form (use with claims experience) – 2019 | 2020Quartz Drug Formulary: Rx Outcomes List
Employee Application (use when no claims experience) – 2019 | 2020Small Group ACA Plans
Employee Questionnaire – 2019 | 2020Small Group Creditable Coverage – 2019 | Learn More
Employee Census Template
CMS Survey 
Waiver of Coverage Form 2019 | 2020 
Domestic Partner Affidavit 2019 | 2020 
Individual & Family Forms

Individual & Family Forms

Individual ApplicationPlan Options
Performance Network - EnglishPerformance Network Plans - 2019
Performance Network - SpanishPerformance Network CSR Plans - 2019