Frequently Used
Group Health Insurance Forms

For our Group Client's convenience, we have added links to download PDF files of the most up to date and frequently used forms below.  Simply print the form you need, have your employee complete the pre-highlighted sections, and fax the form back to us at (636) 441-3123. 

Anthem Blue Cross and Blue Shield Change Form

Anthem Blue Cross and Blue Shield Enrollment Form

Anthem Blue Cross and Blue Shield Life Application (Short Form)
For employees enrolling when they are first eligible, after their initial waiting period, for life insurance amounts less than or equal to $30,000.

Anthem Blue Cross and Blue Shield Life Application (Long Form)
For employees considered late enrollees, applying after their initial waiting period, for life insurance amounts greater than $30,000.

Essex Dental Enrollment & Change Form

GHP Enrollment & Change Form

Mercy Change Form

Mercy Enrollment Form

UnitedHealthcare Enrollment Form

If you require assistance completing the appropriate form, please call one of our Licensed Benefit Consultants at (636) 229-LANG.  Thank you for the opportunity to be of service!