Employer Forms

Applications

For all groups

• Employer Group Application (For employer to complete)

If your group has fewer than 50 employees

• Small Employer Uniform Employee Application for Group Health Insurance (For employee to complete)
• Employee Group Medically Underwritten Enrollment Application (For new hires and changes)

If your group has more than 50 employees

• Employee Group Enrollment Application
• Employee Self-Funded Plan Enrollment Application

New Hire/Change Forms

• For groups with less than 50 employees
• For groups with more than 50 employees

Support Information

• Online Enrollment – Instructions for Employees (Groups 50+)
• Online Enrollment – Instructions for Employers (Groups 50+)
• Understanding Your Billing Statement Brochure (for Employers)
• Understanding Your Explanation of Benefits Brochure (for Employees)
• Employer web tools (for Employers)

How to Register-Employers

Call 888-915-5618 to receive information on how to register for the secure Employer area of the site. Group Leaders will need to submit the appropriate access agreement form (see below).

• Access agreement form for groups of less than 100 employees
• Access agreement form for groups of 100 or more employees

HealthSense Rewards

This discount program rewards your employees for adopting healthy habits and leading healthy lifestyles.

• Learn more about HealthSense Rewards

CMS (Medicare Part D) Information

Updated Guidance and Model Notices: The Centers for Medicare and Medicaid Services (CMS) issued updated creditable coverage guidance and model notices thattook effect January 1, 2009. All updates are related to revisions to the model notices. CMS has decided to eliminate the "Model Personalized Disclosure Notice." Instead, the remaining two model notices include an optional insert that you can complete if you need to provide a personalized notice.

• Visit the CMS website

HIPAA Forms and Documents

This provides a collection of HIPAA forms and documents, particularly those regarding PHI (personal health information).

• Notice of Privacy Practices
• Appeals/Grievance Authorized Representative Form
• Authorization for WPS to Disclose Health Information
• General Authorization to Use and Disclose Health Information
• Request to Access PHI
• Request to Amend PHI