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Attention: We’re experiencing a high volume of calls and emails, causing delays in response times. We apologize for any inconvenience and appreciate your patience.

To view benefit information and claim status at any time, you can sign into your account or use our Interactive Voice Response System 24/7 at 800-452-9310.
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Holiday Hours: Happy Holidays! Cheers to a year ahead full of health, happiness, and confident smiles. Holiday hours schedule

Small Group Forms for Brokers

Easily access and download all the small group forms and applications.

Small Business 2-50 enrolled employees

Easy employer application (PDF, 8 pages, 2,490 KB)
Download our easy group application for 2-50 business

Simple employee enrollment (PDF, 1 page, 204 KB)
Download our easy group enrollment form for 2-50 business

Enrollment spreadsheet (Excel)
Download our easy group enrollment spreadsheet guide for 2-50 business