Group Materials
For Your Business
Forms and Resources
- Active&Fit Direct Flier
- Benefit Administrator’s Guide( IL)
- Benefit Administrator’s Guide( WA)
- BPC Service Setup Sheet
- Student Extended Network Program Flier
- HIPAA Authorization Form
- HIPAA Authorization Form (En español)
- Key Things to Know and Do
- Online Premium Bill Pay Flier (IL, IN members)
- Online Premium Bill Pay Flier (WA members)
- Self-Funded BenefitFocus Flier
- Small Group Vision Buy Up
- Small Group Dental Buy Up
- Small Group EHB Vision/Dental Private Flier
- IA Small Group EHB Vision/Dental Private Flier
- Treatment Cost Calculator Flier
- Why Choose a Self-Funded Plan?
- Hally Virtual Visit Member Flier
- Healthy Extras Flier – IL/IN Employers
- Healthy Extras Flier – WA Employers
- Helping You Be Your Best – IL/IN SF Employers/Members
- Helping You Be Your Best – WA SF Employers/Members
Medicare Materials
Applications
2024 Small Group
- 2024 Illinois and Indiana – Small Group Employer Application
- 2024 Illinois and Indiana – Small Group Employee Application
- 2024 Simplete – Small Group Employer Application
- 2024 Simplete – Small Group Employee Application
- 2024 Iowa – Small Group Employer Application
- 2024 Iowa – Small Group Employee Application
- 2024 WA – Small Group Employer Application
- 2024 WA – Small Group Employee Application
2023 Small Group
- 2023 Illinois and Indiana – Small Group Employer Application
- 2023 Illinois and Indiana – Small Group Employee Application
- 2023 Simplete – Small Group Employer Application
- 2023 Simplete – Small Group Employee Application
- 2023 Iowa – Small Group Employer Application
- 2023 Iowa – Small Group Employee Application
- 2023 WA – Small Group Employer Application
- 2023 WA – Small Group Employee Application