Forms & Documents

Below you will find many of the forms and documents needed at various times in order to complete the application process or to effectively manage an existing Group Policy.  Some forms are state specific - this is due largely to the difference in insurance laws of Wisconsin and Illinois. 

WI Change of Status Form	IL Change of Status Form
WI Individual Group Application
WI Waiver of Coverage Form	ACH Debit Form
PHI Release Form
Member Handbook	Privacy Notice
Drug Reimbursement Form

Should you have any questions regarding the forms and documents listed here, feel free to contact the Sales & Marketing Department Secretary at (608) 758-7718 or an Account Executive at (608) 752-3431 or (800) 752-3431.