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 Submitting Experience Data New Group Checklist - Large Group Submitting Health Applications | Quartz Drug Formulary: $0 Copay List |
| Large Group Census Template | Quartz Drug Formulary: RX Outcomes List |
| Creditable Coverage – 2020 | 2021 | Learn More | Quartz High-Deductible Health Plan $0 Safe Harbor Drug List |
New Small Group Forms | Existing Group Forms |
| Small Group Enrollment Kit | 2019 Benefit Overviews |
| Small Group Employee Application | CMS Survey |
| Small Group ACA Plans - 2019 |
2020 | New Hire Application / Change Form |
| Small Group Census Template | COBRA Group Continuation Notice |
| Creditable Coverage - 2020 | 2021 | Learn more | |
| Creditable Coverage - Transitional Plans - 2020 | 2021 | |
| Small Group Transitional / KYP Plans | |
| Small Group Underwriting Reference Guide | |
| Quartz Drug Formulary: $0 Copay List | |
| Quartz Drug Formulary: RX Outcomes List | |
| Quartz High-Deductible Health Plan $0 Safe Harbor Drug List |
Individual Application | Individual Plan Options |
| English | Quartz One - Standard Plans | CSR Plans |
| Spanish | Beloit One - Standard Plans | CSR Plans |
| Domestic Partner Affidavit |
Individual Application | Individual Plan Options |
| English | Quartz One - Standard Plans | CSR Plans |
| Spanish | Quartz Prime - Standard Plans | CSR Plans |
| Domestic Partner Affidavit | Beloit One - Standard Plans | CSR Plans |
