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

Title Download State
Accident Claim Form Download PDF (382.46 KB) AK, CA, ID, MT, OR, UT, WA, WY
Accidental Death & Dismemberment Employee Flyer Download PDF (1.99 MB) AK, CA, MT, OR, UT, WA, WY
Accidental Death & Dismemberment Employee Flyer - ID Download PDF (1.99 MB) ID
Accidental Dismemberment Claim Form Download PDF (339.79 KB) AK, CA, ID, MT, OR, UT, WA, WY
ADA Dental Claim Form Download PDF (915.03 KB) AK, CA, ID, MT, OR, UT, WA, WY
Affidavit of Non-State Certified Domestic Partnership Download PDF (69.45 KB) OR
Affidavit of Non-State Registered Domestic Partnership Download PDF (69.06 KB) WA
Affidavit of Qualified Disabled Dependent Download PDF (116.01 KB) AK, CA, ID, MT, OR, UT, WA, WY
Affidavit of Qualifying Domestic Partnership Download PDF (68.82 KB) AK, CA, ID, MT, UT, WY
Agent Standard Commission Schedule - Alaska Download PDF (950.69 KB) AK
Agent Standard Commission Schedule - MT Download PDF (953.75 KB) MT
Agent Standard Commission Schedule - OR, ID, UT Download PDF (958.14 KB) ID, OR, UT
Agent Standard Commission Schedule - WA Download PDF (955.2 KB) WA
Agent Standard Commission Schedule - WY Download PDF (951.57 KB) WY
Beneficiary Designation Form Download PDF (60.78 KB) AK, CA, ID, MT, OR, UT, WA, WY
Billing FAQ Download PDF (182.19 KB) AK, CA, ID, MT, OR, UT, WA, WY
Cancer Only Critical Illness Employee Flyer Download PDF (2.04 MB) AK, MT, OR, UT, WA, WY
Cancer Only Critical Illness Employee Flyer - ID Download PDF (2.04 MB) ID
Cancer Plus Critical Illness Employee Flyer Download PDF (2.17 MB) AK, MT, OR, UT, WA, WY
Cancer Plus Critical Illness Employee Flyer - ID Download PDF (2.17 MB) ID
Critical Illness Cancer Care Claim Form Download PDF (148.39 KB) AK, CA, ID, MT, OR, UT, WA, WY
Dental Health Article for Employees Download PDF (91.36 KB) AK, CA, ID, MT, OR, UT, WA, WY
Dental Overview for Employers 2-299 Download PDF (232.16 KB) AK, MT, OR, UT, WA, WY
Dental Overview for Employers 300+ Download PDF (189.4 KB) AK, MT, OR, UT, WA, WY
Dental Overview for ID Employers 2-299 Download PDF (232.99 KB) ID
Dental Overview for ID Employers 300+ Download PDF (189.99 KB) ID
Dental Voluntary Group Employee Flyer Download PDF (2.16 MB) AK, MT, OR, UT, WA, WY
Dental Waiver Form Download PDF (77.75 KB) AK, CA, ID, MT, OR, UT, WA, WY
Direct Deposit Form for Claim Benefits Download PDF (73.49 KB) AK, CA, ID, MT, OR, UT, WA, WY
Dollar-Based Dental for Employees Download PDF (90.6 KB) OR, UT, WA
Dollar-Based Dental for Employees - ID Download PDF (1.76 MB) ID
Dollar-Based Dental for Employers Download PDF (89.53 KB) OR, UT, WA
Dollar-Based Dental for Idaho Employers Download PDF (89.79 KB) ID
Employer Admin Center User Guide and FAQ Download PDF (1.47 MB) AK, CA, ID, MT, OR, UT, WA, WY
Employer Admin Guide - Traditional Download PDF (106.17 KB) AK, CA, ID, MT, OR, UT, WA, WY
Employer Service Directory - 2-9 Express Groups Download PDF (31.15 KB) AK, CA, ID, MT, OR, UT, WA, WY
Enrollment Change Form with Beneficiary Designation Download PDF (206.09 KB) AK, CA, ID, MT, OR, UT, WA, WY
Evidence of Insurability (EOI) with HIPAA Authorization Download PDF (577.64 KB) AK, CA, ID, MT, OR, UT, WA, WY
Express Group Basic Life and ADD Benefit Summary Download PDF (76.98 KB) AK, ID, MT, OR, UT, WA, WY
Express Group Basic Life and ADD Plan Options Download PDF (75.1 KB) AK, ID, MT, OR, UT, WA, WY
Express Group Dental Benefit Summary Download PDF (72.39 KB) ID, OR, UT, WA
Express Group Dental Plan Options Download PDF (84.11 KB) ID, OR, UT, WA
Express Group LTD Benefit Summary Download PDF (74.03 KB) AK, ID, MT, OR, UT, WA, WY
Express Group STD Benefit Summary Download PDF (75.68 KB) AK, ID, MT, OR, UT, WA, WY
Express Group Vision Benefit Summary Download PDF (78.44 KB) AK, ID, MT, OR, UT, WA, WY
Express Group Vision Plan Options Download PDF (73.96 KB) AK, ID, MT, OR, UT, WA, WY
Express Group Voluntary Life and ADD Benefit Summary Download PDF (76.88 KB) AK, ID, MT, OR, UT, WA, WY
Express Group Voluntary Life and ADD Plan Options Download PDF (76.56 KB) AK, ID, MT, OR, UT, WA, WY
Express Groups 2-9 Service Directory Download PDF (31.15 KB) AK, CA, ID, MT, OR, UT, WA, WY
Express Groups STD and LTD Plan Options Download PDF (77.31 KB) AK, ID, MT, OR, UT, WA, WY
Extended Life Insurance Claim Form Download PDF (163.23 KB) AK, CA, ID, MT, OR, UT, WA, WY
Find a Dentist Download PDF (82.62 KB) AK, CA, ID, MT, OR, UT, WA, WY
Find a Vision Provider - Group Download PDF (185.93 KB) AK, ID, MT, OR, UT, WA, WY
Group Dental Employee Flyer Download PDF (1.59 MB) AK, CA, MT, OR, UT, WA, WY
Group Dental Employee Flyer - ID Download PDF (1.59 MB) ID
Group Products Overview 10+ Download PDF (760.88 KB) AK, MT, OR, UT, WA, WY
Group Products Overview 10+ CA Download PDF (2.3 MB) CA
Group Products Overview 10+ ID Download PDF (763.5 KB) ID
Group Products Overview Express 2-9 CA Download PDF (1.16 MB) CA
HIPAA Authorization to Disclose Protected Health Information Download PDF (259.78 KB) AK, CA, ID, MT, OR, UT, WA, WY
Individual Critical Illness Plus Application - ID Download PDF (857.59 KB) ID
Individual Critical Illness Plus Application - OR Download PDF (174.54 KB) OR
Individual Critical Illness Plus Application - WA Download PDF (1.03 MB) WA
Individual Critical Illness Plus Beneficiary Form Download PDF (83.93 KB) ID, OR, UT, WA
Individual Critical Illness Plus Enrollment Packet- UT Download PDF (723.12 KB) UT
Individual Critical Illness Plus Flyer Download PDF (112.64 KB) OR, UT, WA
Individual Critical Illness Plus Flyer - ID Download PDF (113.27 KB) ID
Individual Dental Application - ID Download PDF (136.36 KB) ID
Individual Dental Application - OR Download PDF (1.13 MB) OR
Individual Dental Application - UT Download PDF (131.54 KB) UT
Individual Dental Application - WA Download PDF (1.22 MB) WA
Individual Dental Member Brochure - ID Download PDF (193.48 KB) ID
Individual Dental Member Brochure - OR Download PDF (2.2 MB) OR
Individual Dental Member Brochure - UT Download PDF (193.42 KB) UT
Individual Dental Member Brochure - WA Download PDF (2.2 MB) WA
Individual Dental Rates 01/01/2018 to 03/31/2018 - ID Download PDF (28.07 KB) ID
Individual Dental Rates 01/01/2018 to 03/31/2018 - OR Download PDF (31.75 KB) OR
Individual Dental Rates 01/01/2018 to 03/31/2018 - UT Download PDF (38.73 KB) UT
Individual Dental Rates 01/01/2018 to 03/31/2018 - WA Download PDF (29.09 KB) WA
Individual Dental Rates 04/01/2018 to 06/30/2018 - ID Download PDF (333.75 KB) ID
Individual Dental Rates 04/01/2018 to 06/30/2018 - OR Download PDF (224.39 KB) OR
Individual Dental Rates 04/01/2018 to 06/30/2018 - UT Download PDF (339.76 KB) UT
Individual Dental Rates 04/01/2018 to 06/30/2018 - WA Download PDF (334.22 KB) WA
Individual Short Term Medical Enrollment Packet - ID Download PDF (509.22 KB) ID
Individual Short Term Medical Enrollment Packet - OR Download PDF (992.36 KB) OR
Individual Short Term Medical Enrollment Packet - UT Download PDF (446.73 KB) UT
Individual Short Term Medical Enrollment Packet - WA Download PDF (1.17 MB) WA
Individual Short Term Medical Member Flyer Download PDF (915.92 KB) OR, UT, WA
Individual Short Term Medical Member Flyer - ID Download PDF (208.81 KB) ID
Individual Short Term Medical Pharmacy Reimbursement Form Download PDF (32.81 KB) ID, MT, OR, UT, WA
Individual Short Term Medical Rates - Idaho Eff 4/1/2018 to 6/30/2018 Download PDF (32.36 KB) ID
Individual Short Term Medical Rates - Oregon Eff 4/1/2018 to 6/30/2018 Download PDF (25.86 KB) OR
Individual Short Term Medical Rates - Utah Eff 4/1/2018 to 6/30/2018 Download PDF (26.38 KB) UT
Individual Short Term Medical Rates - Washington Eff 4/1/2018 to 6/30/2018 Download PDF (55.35 KB) WA
Individual Short Term Medical Rates 01/01/2018 to 03/31/2018 - ID Download PDF (68.11 KB) ID
Individual Short Term Medical Rates 01/01/2018 to 03/31/2018 - OR Download PDF (60.08 KB) OR
Individual Short Term Medical Rates 01/01/2018 to 03/31/2018 - UT Download PDF (60.2 KB) UT
Individual Short Term Medical Rates 01/01/2018 to 03/31/2018 - WA Download PDF (60.15 KB) WA
Individual Vision Rider Reimbursement Form Download PDF (33.05 KB) ID, OR, UT
Life Conversion Request for Information Form Download PDF (228.07 KB) AK, CA, ID, MT, OR, UT, WA, WY
Life Employee Flyer Download PDF (2.15 MB) AK, CA, MT, OR, UT, WA, WY
Life Insurance Claim Form Download PDF (284.21 KB) AK, CA, ID, MT, OR, UT, WA, WY
Life Insurance Worksheet Download PDF (142.3 KB) AK, CA, MT, OR, UT, WA, WY
Life Insurance Worksheet - Idaho Download PDF (141.89 KB) ID
LifeMap Advantages Beltone ID Card Download PDF (41.49 KB) AK, CA, ID, MT, OR, UT, WA, WY
LifeMap Advantages Member Flyer Download PDF (823.59 KB), Download PDF (825.01 KB) AK, CA, ID, MT, OR, UT, WA, WY
LifeMap Group Producers 2017 Incentive Program Download PDF (604.36 KB) ID, OR, UT, WA
Long Term Disability Claim Form Download PDF (570.96 KB) AK, CA, ID, MT, OR, UT, WA, WY
Long Term Disability Employee Flyer Download PDF (2.09 MB) AK, CA, MT, OR, UT, WA, WY
Long Term Disability Employee Flyer - ID Download PDF (2.09 MB) ID
Notice of Privacy Practices - STM, Vision, Dental Download PDF (126.25 KB) AK, CA, ID, MT, OR, UT, WA, WY
Privacy Notice Download PDF (24.05 KB) AK, CA, ID, MT, OR, UT, WA, WY
Provider EFT Enrollment Form Download PDF (225.17 KB) AK, CA, ID, MT, OR, UT, WA, WY
Short Term Disability Claim Form Download PDF (772.04 KB) AK, ID, MT, OR, UT, WA, WY
Short Term Disability Overview for Employers Download PDF (486.03 KB) AK, MT, OR, UT, WA, WY
Short Term Disability Overview for ID Employers Download PDF (486.52 KB) ID
STM Authorization For Use and Disclosure of Protected Health Information Download PDF (129.8 KB) ID, MT, OR, UT, WA
Vision Employee Flyer Download PDF (1.31 MB) AK, MT, OR, UT, WA, WY
Vision Employee Flyer - ID Download PDF (1.31 MB) ID
Vision Employee Waiver Form Download PDF (243.78 KB) AK, ID, MT, OR, UT, WA, WY
Vision Out of Network Reimbursement Form Download PDF (293.57 KB) AK, ID, MT, OR, UT, WA, WY
Voluntary Accident Employee Flyer Download PDF (3.09 MB) AK, MT, OR, UT, WA, WY
Voluntary Accident Employee Flyer - ID Download PDF (3.09 MB) ID
Voluntary Accidental Death & Dismemberment Employee Flyer Download PDF (1.99 MB) AK, MT, OR, UT, WA, WY
Voluntary Accidental Death & Dismemberment Employee Flyer - ID Download PDF (1.99 MB) ID
Voluntary Group Dental Employee Flyer Download PDF (1.09 MB) AK, MT, OR, UT, WA, WY
Voluntary Group Dental Employee Flyer - ID Download PDF (2.41 MB) ID
Voluntary Life Employee Flyer Download PDF (2.16 MB) AK, MT, OR, UT, WA, WY
Voluntary Life Employee Flyer ID Download PDF (2.16 MB) ID
Voluntary Long Term Disability Employee Flyer Download PDF (260.77 KB) AK, MT, OR, UT, WA, WY
Voluntary Long Term Disability Employee Flyer - ID Download PDF (261.1 KB) ID
Voluntary Short Term Disability Employee Flyer Download PDF (1.33 MB) AK, MT, OR, UT, WA, WY
Voluntary Short Term Disability Employee Flyer - ID Download PDF (1.33 MB) ID
Wellness Benefit Statement Download PDF (65.09 KB) AK, CA, ID, MT, OR, UT, WA, WY