Forms Center

Enrollment & Eligibility Forms

• Enrollment Change Form
  • Use to make changes to a group’s enrollment. For example: add, terminate or change an employee or dependent’s coverage.
  • English (PDF) | Spanish (PDF)
• Enrollment Change Form – Individual and Family
  • Use to make changes to an Individual and Family Policy during the year when dependents have a Qualifying Life Event.
  • English (PDF)
• Waiver of Health Coverage Benefits
  • Use this form for each employee who is waiving coverage. Be sure to have the employee provide a copy of his/her insurance card, if applicable.
  • English (PDF) | Spanish (PDF)
• Commercial Group Application
  • Use one of these forms to begin a small group or association health plan application.
  • Small Group Application Checklist
  • AHP – Carson Chamber Application Checklist
  • AHP – The Builders Application Checklist
• Eligibility and Payment
  • Use during open enrollment period to make changes to eligibility provisions.
  • Group Eligibility and Payment Provisions (PDF)