Please note: The state field refers to the location where your employer is headquartered.

Title Download State
Accident Claim Form PDF icon Download PDF (382.46 KB) AK, CA, ID, MT, OR, UT, WA, WY
Accidental Death & Dismemberment Employee Flyer PDF icon Download PDF (1.99 MB) AK, CA, MT, OR, UT, WA, WY
Accidental Death & Dismemberment Employee Flyer - ID PDF icon Download PDF (1.99 MB) ID
Accidental Dismemberment Claim Form PDF icon Download PDF (339.79 KB) AK, CA, ID, MT, OR, UT, WA, WY
ADA Dental Claim Form PDF icon Download PDF (915.03 KB) AK, CA, ID, MT, OR, UT, WA, WY
Affidavit of Non-State Certified Domestic Partnership PDF icon Download PDF (69.45 KB) OR
Affidavit of Non-State Registered Domestic Partnership PDF icon Download PDF (69.06 KB) WA
Affidavit of Qualified Disabled Dependent PDF icon Download PDF (116.01 KB) AK, CA, ID, MT, OR, UT, WA, WY
Affidavit of Qualifying Domestic Partnership PDF icon Download PDF (68.82 KB) AK, CA, ID, MT, UT, WY
Agent Standard Commission Schedule - Alaska PDF icon Download PDF (950.69 KB) AK
Agent Standard Commission Schedule - MT PDF icon Download PDF (953.75 KB) MT
Agent Standard Commission Schedule - OR, ID, UT PDF icon Download PDF (958.14 KB) ID, OR, UT
Agent Standard Commission Schedule - WA PDF icon Download PDF (955.2 KB) WA
Agent Standard Commission Schedule - WY PDF icon Download PDF (951.57 KB) WY
Beneficiary Designation Form PDF icon Download PDF (60.78 KB) AK, CA, ID, MT, OR, UT, WA, WY
Billing FAQ PDF icon Download PDF (325.67 KB) AK, CA, ID, MT, OR, UT, WA, WY
Cancer Only Critical Illness Employee Flyer PDF icon Download PDF (2.04 MB) AK, MT, OR, UT, WA, WY
Cancer Only Critical Illness Employee Flyer - ID PDF icon Download PDF (2.04 MB) ID
Cancer Plus Critical Illness Employee Flyer PDF icon Download PDF (2.17 MB) AK, MT, OR, UT, WA, WY
Cancer Plus Critical Illness Employee Flyer - ID PDF icon Download PDF (2.17 MB) ID
Critical Illness Cancer Care Claim Form PDF icon Download PDF (148.39 KB) AK, CA, ID, MT, OR, UT, WA, WY
Dental Health Article for Employees PDF icon Download PDF (91.36 KB) AK, CA, ID, MT, OR, UT, WA, WY
Dental Overview for Employers 2-299 PDF icon Download PDF (232.16 KB) AK, MT, OR, UT, WA, WY
Dental Overview for Employers 300+ PDF icon Download PDF (189.4 KB) AK, MT, OR, UT, WA, WY
Dental Overview for ID Employers 2-299 PDF icon Download PDF (232.99 KB) ID
Dental Overview for ID Employers 300+ PDF icon Download PDF (189.99 KB) ID
Dental Voluntary Group Employee Flyer PDF icon Download PDF (2.16 MB) AK, MT, OR, UT, WA, WY
Dental Waiver Form PDF icon Download PDF (77.75 KB) AK, CA, ID, MT, OR, UT, WA, WY
Direct Deposit Form for Claim Benefits PDF icon Download PDF (73.49 KB) AK, CA, ID, MT, OR, UT, WA, WY
Dollar-Based Dental for Employees PDF icon Download PDF (90.6 KB) OR, UT, WA
Dollar-Based Dental for Employees - ID PDF icon Download PDF (1.76 MB) ID
Dollar-Based Dental for Employers PDF icon Download PDF (89.53 KB) OR, UT, WA
Dollar-Based Dental for Idaho Employers PDF icon Download PDF (89.79 KB) ID
Employer Admin Center User Guide and FAQ PDF icon Download PDF (1.47 MB) AK, CA, ID, MT, OR, UT, WA, WY
Employer Admin Guide - Traditional PDF icon Download PDF (106.17 KB) AK, CA, ID, MT, OR, UT, WA, WY
Enrollment Change Form with Beneficiary Designation PDF icon Download PDF (206.09 KB) AK, CA, ID, MT, OR, UT, WA, WY
Evidence of Insurability (EOI) with HIPAA Authorization PDF icon Download PDF (75.34 KB) AK, CA, ID, MT, OR, UT, WA, WY
Express Group Basic Life and ADD Benefit Summary PDF icon Download PDF (76.98 KB) AK, ID, MT, OR, UT, WA, WY
Express Group Basic Life and ADD Plan Options PDF icon Download PDF (75.1 KB) AK, ID, MT, OR, UT, WA, WY
Express Group Dental Benefit Summary PDF icon Download PDF (72.39 KB) ID, OR, UT, WA
Express Group Dental Plan Options PDF icon Download PDF (89.33 KB) ID, OR, UT, WA
Express Group Implementation Worksheet (2-9) PDF icon Download PDF (176.83 KB) AK, CA, ID, MT, OR, UT, WA, WY
Express Group LTD Benefit Summary PDF icon Download PDF (74.03 KB) AK, ID, MT, OR, UT, WA, WY
Express Group STD Benefit Summary PDF icon Download PDF (75.68 KB) AK, ID, MT, OR, UT, WA, WY
Express Group Vision Benefit Summary PDF icon Download PDF (78.44 KB) AK, ID, MT, OR, UT, WA, WY
Express Group Vision Plan Options PDF icon Download PDF (73.96 KB) AK, ID, MT, OR, UT, WA, WY
Express Group Voluntary Life and ADD Benefit Summary PDF icon Download PDF (76.88 KB) AK, ID, MT, OR, UT, WA, WY
Express Group Voluntary Life and ADD Plan Options PDF icon Download PDF (76.56 KB) AK, ID, MT, OR, UT, WA, WY
Express Groups 2-9 Service Directory PDF icon Download PDF (33.92 KB) AK, CA, ID, MT, OR, UT, WA, WY
Express Groups STD and LTD Plan Options PDF icon Download PDF (77.31 KB) AK, ID, MT, OR, UT, WA, WY
Extended Life Insurance Claim Form PDF icon Download PDF (163.23 KB) AK, CA, ID, MT, OR, UT, WA, WY
Find a Dentist PDF icon Download PDF (82.62 KB) AK, CA, ID, MT, OR, UT, WA, WY
Find a Vision Provider - Group PDF icon Download PDF (185.93 KB) AK, ID, MT, OR, UT, WA, WY
Group Dental Employee Flyer PDF icon Download PDF (1.59 MB) AK, CA, MT, OR, UT, WA, WY
Group Dental Employee Flyer - ID PDF icon Download PDF (1.59 MB) ID
Group Products Overview 10+ PDF icon Download PDF (760.88 KB) AK, MT, OR, UT, WA, WY
Group Products Overview 10+ CA PDF icon Download PDF (2.3 MB) CA
Group Products Overview 10+ ID PDF icon Download PDF (763.5 KB) ID
Group Products Overview Express 2-9 CA PDF icon Download PDF (1.16 MB) CA
HIPAA Authorization to Disclose Protected Health Information PDF icon Download PDF (259.78 KB) AK, CA, ID, MT, OR, UT, WA, WY
Individual Critical Illness Plus Application - ID PDF icon Download PDF (857.59 KB) ID
Individual Critical Illness Plus Application - OR PDF icon Download PDF (174.54 KB) OR
Individual Critical Illness Plus Application - WA PDF icon Download PDF (1.03 MB) WA
Individual Critical Illness Plus Beneficiary Form PDF icon Download PDF (83.93 KB) ID, OR, UT, WA
Individual Critical Illness Plus Enrollment Packet- UT PDF icon Download PDF (723.12 KB) UT
Individual Critical Illness Plus Flyer PDF icon Download PDF (112.64 KB) OR, UT, WA
Individual Critical Illness Plus Flyer - ID PDF icon Download PDF (113.27 KB) ID
Individual Dental Application - ID PDF icon Download PDF (136.36 KB) ID
Individual Dental Application - OR PDF icon Download PDF (1.13 MB) OR
Individual Dental Application - UT PDF icon Download PDF (131.54 KB) UT
Individual Dental Application - WA PDF icon Download PDF (1.22 MB) WA
Individual Dental Member Brochure - ID PDF icon Download PDF (193.48 KB) ID
Individual Dental Member Brochure - OR PDF icon Download PDF (2.2 MB) OR
Individual Dental Member Brochure - UT PDF icon Download PDF (193.42 KB) UT
Individual Dental Member Brochure - WA PDF icon Download PDF (2.2 MB) WA
Individual Dental Rates 07/01/2018 to 09/30/2018 - ID PDF icon Download PDF (172.62 KB) ID
Individual Dental Rates 07/01/2018 to 09/30/2018 - OR PDF icon Download PDF (221.89 KB) OR
Individual Dental Rates 07/01/2018 to 09/30/2018 - UT PDF icon Download PDF (178.5 KB) UT
Individual Dental Rates 07/01/2018 to 09/30/2018 - WA PDF icon Download PDF (173.88 KB) WA
Individual Dental Rates 10/01/2018 to 12/31/2018 - ID PDF icon Download PDF (127.67 KB) ID
Individual Dental Rates 10/01/2018 to 12/31/2018 - OR PDF icon Download PDF (141.57 KB) OR
Individual Dental Rates 10/01/2018 to 12/31/2018 - UT PDF icon Download PDF (132.62 KB) UT
Individual Dental Rates 10/01/2018 to 12/31/2018 - WA PDF icon Download PDF (128.68 KB) WA
Individual Short Term Medical Enrollment Packet - ID PDF icon Download PDF (509.22 KB) ID
Individual Short Term Medical Enrollment Packet - OR PDF icon Download PDF (992.36 KB) OR
Individual Short Term Medical Enrollment Packet - UT PDF icon Download PDF (446.73 KB) UT
Individual Short Term Medical Enrollment Packet - WA PDF icon Download PDF (1.17 MB) WA
Individual Short Term Medical Member Flyer PDF icon Download PDF (915.92 KB) OR, UT, WA
Individual Short Term Medical Member Flyer - ID PDF icon Download PDF (208.81 KB) ID
Individual Short Term Medical Pharmacy Reimbursement Form PDF icon Download PDF (32.81 KB) ID, MT, OR, UT, WA
Individual Short Term Medical Rates - Idaho Eff 10/1/2018 to 12/31/2018 PDF icon Download PDF (87.88 KB) ID
Individual Short Term Medical Rates - Idaho Eff 7/1/2018 to 9/30/2018 PDF icon Download PDF (166.56 KB) ID
Individual Short Term Medical Rates - Oregon Eff 10/1/2018 to 12/31/2018 PDF icon Download PDF (87.85 KB) OR
Individual Short Term Medical Rates - Oregon Eff 7/1/2018 to 9/30/2018 PDF icon Download PDF (103.62 KB) OR
Individual Short Term Medical Rates - Utah Eff 10/1/2018 to 12/31/2018 PDF icon Download PDF (86.59 KB) UT
Individual Short Term Medical Rates - Utah Eff 7/1/2018 to 9/30/2018 PDF icon Download PDF (166.13 KB) UT
Individual Short Term Medical Rates - Washington Eff 10/1/2018 to 12/31/2018 PDF icon Download PDF (140.66 KB) WA
Individual Short Term Medical Rates - Washington Eff 7/1/2018 to 9/30/2018 PDF icon Download PDF (235.13 KB) WA
Individual Vision Rider Reimbursement Form PDF icon Download PDF (33.05 KB) ID, OR, UT
Initial Premium Invoice PDF icon Download PDF (195.62 KB) AK, CA, ID, MT, OR, UT, WA, WY
Life Conversion Request for Information Form PDF icon Download PDF (228.07 KB) AK, CA, ID, MT, OR, UT, WA, WY
Life Employee Flyer PDF icon Download PDF (2.15 MB) AK, CA, MT, OR, UT, WA, WY
Life Insurance Claim Form PDF icon Download PDF (284.21 KB) AK, CA, ID, MT, OR, UT, WA, WY
Life Insurance Worksheet PDF icon Download PDF (142.3 KB) AK, CA, MT, OR, UT, WA, WY
Life Insurance Worksheet - Idaho PDF icon Download PDF (141.89 KB) ID
LifeMap Advantages Beltone ID Card PDF icon Download PDF (41.49 KB) AK, CA, ID, MT, OR, UT, WA, WY
LifeMap Advantages Member Flyer PDF icon Download PDF (823.57 KB) AK, CA, ID, MT, OR, UT, WA, WY
LifeMap Group Producers Incentive Program PDF icon Download PDF (458.84 KB) AK, CA, ID, MT, OR, UT, WA, WY
Long Term Disability Claim Form PDF icon Download PDF (570.96 KB) AK, CA, ID, MT, OR, UT, WA, WY
Long Term Disability Employee Flyer PDF icon Download PDF (2.09 MB) AK, CA, MT, OR, UT, WA, WY
Long Term Disability Employee Flyer - ID PDF icon Download PDF (2.09 MB) ID
Notice of Privacy Practices - STM, Vision, Dental PDF icon Download PDF (126.25 KB) AK, CA, ID, MT, OR, UT, WA, WY
Privacy Notice PDF icon Download PDF (24.05 KB) AK, CA, ID, MT, OR, UT, WA, WY
Provider EFT Enrollment Form PDF icon Download PDF (225.17 KB) AK, CA, ID, MT, OR, UT, WA, WY
Risk Evaluation Form PDF icon Download PDF (89.29 KB) AK, CA, ID, MT, OR, UT, WA, WY
Short Term Disability Claim Form PDF icon Download PDF (772.04 KB) AK, ID, MT, OR, UT, WA, WY
Short Term Disability Overview for Employers PDF icon Download PDF (486.03 KB) AK, MT, OR, UT, WA, WY
Short Term Disability Overview for ID Employers PDF icon Download PDF (486.52 KB) ID
STM Authorization For Use and Disclosure of Protected Health Information PDF icon Download PDF (129.8 KB) ID, MT, OR, UT, WA
Vision Employee Flyer PDF icon Download PDF (1.31 MB) AK, MT, OR, UT, WA, WY
Vision Employee Flyer - ID PDF icon Download PDF (1.31 MB) ID
Vision Employee Waiver Form PDF icon Download PDF (243.78 KB) AK, ID, MT, OR, UT, WA, WY
Vision Out of Network Reimbursement Form PDF icon Download PDF (293.57 KB) AK, ID, MT, OR, UT, WA, WY
Voluntary Accident Employee Flyer PDF icon Download PDF (3.09 MB) AK, MT, OR, UT, WA, WY
Voluntary Accident Employee Flyer - ID PDF icon Download PDF (3.09 MB) ID
Voluntary Accidental Death & Dismemberment Employee Flyer PDF icon Download PDF (1.99 MB) AK, MT, OR, UT, WA, WY
Voluntary Accidental Death & Dismemberment Employee Flyer - ID PDF icon Download PDF (1.99 MB) ID
Voluntary Group Dental Employee Flyer PDF icon Download PDF (1.09 MB) AK, MT, OR, UT, WA, WY
Voluntary Group Dental Employee Flyer - ID PDF icon Download PDF (2.41 MB) ID
Voluntary Life Employee Flyer PDF icon Download PDF (2.16 MB) AK, MT, OR, UT, WA, WY
Voluntary Life Employee Flyer ID PDF icon Download PDF (2.16 MB) ID
Voluntary Long Term Disability Employee Flyer PDF icon Download PDF (260.77 KB) AK, MT, OR, UT, WA, WY
Voluntary Long Term Disability Employee Flyer - ID PDF icon Download PDF (261.1 KB) ID
Voluntary Short Term Disability Employee Flyer PDF icon Download PDF (1.33 MB) AK, MT, OR, UT, WA, WY
Voluntary Short Term Disability Employee Flyer - ID PDF icon Download PDF (1.33 MB) ID
Wellness Benefit Statement PDF icon Download PDF (65.09 KB) AK, CA, ID, MT, OR, UT, WA, WY