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

Title Download State
Agent Standard Commission Schedule - AK PDF icon Download Form (224.5 KB) AK
Agent Standard Commission Schedule - CA PDF icon Download Form (230.62 KB) CA
Agent Standard Commission Schedule - MT, WY PDF icon Download Form (206.81 KB) MT, WY
Agent Standard Commission Schedule - OR, ID, UT PDF icon Download Form (213.82 KB) ID, OR, UT
Agent Standard Commission Schedule - WA PDF icon Download Form (221.35 KB) WA
Find a Dentist PDF icon Download Form (82.62 KB) AK, CA, ID, MT, OR, UT, WA, WY
Individual Critical Illness and Emergency Treatment Benefit Claim Form PDF icon Download Form (877.17 KB) AK, CA, ID, MT, OR, UT, WA, WY
Individual Dental Enrollment Packet - ID PDF icon Download Form (914.11 KB) ID
Individual Dental Enrollment Packet - OR PDF icon Download Form (1.13 MB) OR
Individual Dental Enrollment Packet - UT PDF icon Download Form (921.42 KB) UT
Individual Dental Enrollment Packet - WA PDF icon Download Form (1.22 MB) WA
Individual Dental Member Brochure - ID PDF icon Download Form (193.48 KB) ID
Individual Dental Member Brochure - OR PDF icon Download Form (2.2 MB) OR
Individual Dental Member Brochure - UT PDF icon Download Form (193.42 KB) UT
Individual Dental Member Brochure - WA PDF icon Download Form (2.2 MB) WA
Individual Dental Rates 01/01/2023 to 03/31/2023 - ID PDF icon Download Form (605.99 KB) ID
Individual Dental Rates 01/01/2023 to 03/31/2023 - OR PDF icon Download Form (612.42 KB) OR
Individual Dental Rates 01/01/2023 to 03/31/2023 - UT PDF icon Download Form (606 KB) UT
Individual Dental Rates 01/01/2023 to 03/31/2023 - WA PDF icon Download Form (609.07 KB) WA
Individual Dental Rates 10/01/2022 to 12/31/2022 - ID PDF icon Download Form (605.89 KB) ID
Individual Dental Rates 10/01/2022 to 12/31/2022 - OR PDF icon Download Form (612.35 KB) OR
Individual Dental Rates 10/01/2022 to 12/31/2022 - UT PDF icon Download Form (605.87 KB) UT
Individual Dental Rates 10/01/2022 to 12/31/2022 - WA PDF icon Download Form (608.91 KB) WA
Individual Short Term Medical Pharmacy Reimbursement Form PDF icon Download Form (32.81 KB) ID, OR, UT, WA
Individual Vision Rider Reimbursement Form PDF icon Download Form (171.27 KB) ID, OR, UT
LifeMap Advantages Member Flyer PDF icon Download Form (885.84 KB) AK, CA, ID, MT, OR, UT, WA, WY
STM Authorization For Use and Disclosure of Protected Health Information PDF icon Download Form (129.8 KB) ID, OR, UT, WA