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 – 2021 | Learn More | Quartz High-Deductible Health Plan $0 Safe Harbor Drug List |
New Small Group Forms | Existing Group Forms |
Small Group Employee Application | New Hire Application / Change Form |
Small Group ACA Plans - 2021 | 2020 | COBRA Group Continuation Notice |
Small Group Census Template | Creditable Coverage - 2021 | Learn more |
Small Group Enrollment Kit | Creditable Coverage - Transitional Plans - 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 |