Group Forms | Blue Cross and Blue Shield of Illinois | Humana
IAC | Starmark | Time | Trustmark | UnitedHealthcare
Enrollment Kit as One File (Medical, Dental & Life) |
| Full Enrollment Kit |
| Enrollment Kit as Separate Forms (Medical, Dental & Life) |
| Humana Checklist |
| Employer Business Information Application (3/08) |
| Employer Medical Selection Application 2-99 (3/08) |
| Employer Dental Application (3/08) |
| Employer Vision Application (3/08) |
| Employer Life Application (3/08) |
| Employee Application 2-50 (3/08) |
Personal Care Account (PCA) Forms |
| Employer Group Application PCA |
| Miscellaneous Forms |
| Humana Dependent Information |
| Additional Details to Medical Questions |
| Multi-location Form |
| Eligibility Certification Form |
| Consent for Release of PHI |
| 51+ Risk Assessment Form |
| Full-time Employment Questionnaire |