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 | Quartz Drug Formulary: $0 Copay List |
| Large Group Census Template | Quartz Drug Formulary: RX Outcomes List |
| Creditable Coverage – 2020 | Learn More | Quartz High-Deductible Health Plan $0 Safe Harbor Drug List |
New Small Group Forms | Existing Group Forms |
| Small Group Enrollment Kit | Benefit Overviews 2018 | 2019 |
| Small Group Employee Application | CMS Survey |
| Small Group ACA Plans - 2018 | 2019 |
2020 | New Hire Application / Change Form |
| Small Group Census Template | COBRA Group Continuation Notice |
| Creditable Coverage - 2019 | 2020 | Learn more | |
| Creditable Coverage - Transitional Plans | |
| 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 | Quartz Prime - Standard Plans | CSR Plans |
| Beloit One - Standard Plans | CSR Plans |
Recurring Payment Authorization Form
Individual Application | Individual Plan Options |
| Elite Network — English |
Spanish | Prime Network Plans — Standard | CSR |
| Prime Network — English | Spanish | Elite Network Plans — Standard | CSR |
| Beloit One Network — English | Spanish | Beloit One Network Plans — Standard | CSR |
| Pioneer One Network — English |
Spanish | Pioneer One Network Plans — Standard | CSR |
| Gundersen Health System® on Elite Plans — Standard | CSR | |
| ProHealth on Elite Plans — Standard | CSR |
