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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 |
| 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 (89.33 KB) |
ID, OR, UT, WA |
| Express Group Implementation Worksheet (2-9) |
Download PDF (176.83 KB) |
AK, CA, ID, MT, OR, UT, WA, WY |
| 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 (33.95 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 |
| Initial Premium Invoice |
Download PDF (195.62 KB) |
AK, CA, ID, MT, OR, UT, WA, WY |
| 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 Incentive Program |
Download PDF (458.84 KB) |
AK, CA, ID, MT, OR, UT, WA, WY |
| 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 |
| Risk Evaluation Form |
Download PDF (89.29 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 |