Forms
Ready to apply? Looking for a participating doctor? These forms can help.
Individual & Family Plan Enrollment Applications
Standard Health Plans
Temporary Health Plans
Physician and Hospital Finder
Select Health Large Employer Forms
Select Health Small Employer Forms
- Employee Application
- Change Form
- Master Group Contract Application & Execution Section
- New Group Data Summary
- New Group Enrollment Requirements
- Waiver form
Humana Group Forms
- Additional Dependent Information Form
- Employee Change Form
- Employee Enrollment Form – 51-99 Employees
- Employee Enrollment Form – 2-50 Employees
- Employer Group Application
- Small Group Medical
United Health Care Group Forms
- Scheduled Direct Debit
- Enrollment Application/Change/Cancellation Request- Over 50 Employees
- Employee Enrollment Form – 2-99 Employees
- Employer Application for Small Business
- Health Addendum To Employer Application
- Online Payment Remittance
- Pharmacy Reimbursement Claim Form
Regence BCBS of Utah Large Employer Forms
- Group Application Form
- Application for Enrollment / Waiver
- Risk Evaluation Form
- Short Form Health Questionnaire and Medical History Statement
Regence BCBS Small Employer Forms
- Group Application Form
- COBRA Continuation or State Extension Application
- Application for Enrollment / Waiver
- Group Change Form
- Group Health Questionnaire
- Underwriting Assumptions and Requirements
Altius Large Employer Forms
- Change / Delete
- Large Group Enrollment Form
- Large Group Application Form
- Waiver Form
- Employee Statement of Health
- Large Group Information Form
- Risk Evaluation Form
Altius Small Employer Forms
Carrier Links
- HumanaOne
- SelectHealth
- Altius
- Blue Cross & Blue Shield
- HIP Utah
- Dental Select
- Brokers National
- Anthem BCBS
- Health Equity
- MGIS
- Ameritas
- Midland National
- Assurant Health
- West Coast Life
- Aetna
- Humana
- United Health Care
Feeling Lost?
Try these informational brochures regarding some of the insurance polices available.