Forms

Broker of Record Letter
General Census Spreadsheet
HIPAA Authorization Form
Broker Mediation Form

Group Screener

RFP Kit – (groups of 2-50 employees)  All Coverages and Plans
RFP Kit – (groups of 2-50 employees)  Health, Dental & Vision Only
RFP Kit – (groups of 2-50 employees)  Life & Disability Only

RFP Kit – (groups of 50+ employees)   All Coverages and Plans
RFP Kit – (groups of 50+ employees)   Health, Dental & Vision Only
RFP Kit – (groups of 50+ employees)   Life & Disability Only