New Large Group Forms | Existing Large Group Forms |
| Employer Group Application | Employee Application for New Hire |
Employee Application Form — English | Spanish(Use when no claims experience) | Waiver of Coverage Form — English | Spanish |
Employee Application Form — English
| Spanish(Use with claims experience) | COBRA Group Continuation Notice |
| New Group Checklist - Large Group | Unity Drug Formulary: $0 Copay List |
| Large Group Census Template | Unity Drug Formulary: RX Outcomes List |
New Small Group Forms | Existing Group Forms |
| Small Group Enrollment Kit | Benefit Overviews 2018 | 2019 |
| Small Group Employee Application | CMS Survey - 2019 |
| Small Group ACA Plans - 2018 | 2019 | New Hire Application / Change Form |
| Small Group Census Template | COBRA Group Continuation Notice |
| State Group Continuation Notice | |
| Creditable Coverage - 2019 | |
| Small Group Transitional / KYP Plans | |
| Small Group Underwriting Reference Guide | |
| Quartz Drug Formulary: $0 Copay List | |
| Quartz Drug Formulary: RX Outcomes List |
Individual Application | Individual Plan Options |
| English | Prime Network Plans — 2018 | 2019 |
| Elite Network — 2018 | 2019 | Prime Network CSR Plans — 2018 | 2019 |
| Prime Network — 2018 | 2019 | Elite Network Plans — 2018 | 2019 |
| Beloit One Network — 2018 | 2019 | Elite Network CSR Plans — 2018 | 2019 |
| Pioneer One Network — 2018 | 2019 | Beloit One Network Plans — 2018 | 2019 |
| Spanish | Beloit One Network CSR Plans — 2018 | 2019 |
| Elite Network — 2018 | 2019 | Pioneer One Network Plans — 2018 | 2019 |
| Prime Network — 2018 | 2019 | Pioneer One Network CSR Plans — 2018 | 2019 |
| Beloit One Network — 2018 | 2019 | Gundersen Health System® on Elite Plans — 2018 | 2019 |
| Pioneer One Network — 2018 | 2019 | Gundersen Health System® CSR on Elite Plans — 2018 | 2019 |
| Recurring Payment Authorization Form | ProHealth on Elite Plans — 2018 | 2019 |
| ProHealth CSR on Elite Plans — 2018 | 2019 |
