Small Group Applications (for groups with 100 or fewer full-time equivalent eligible employees)

Large Group Applications (for groups with 101 or more full-time equivalent eligible employees)

Underwriting Guidelines

Managing Members – Forms

NOTE: The forms on this page are available as Adobe® PDF files. You will need Adobe Reader®, a free program from Adobe, to download and print the forms. Click here to get Adobe Reader now. Follow Adobe’s instructions for download and installation. Print out the appropriate form and mail it to the address listed on the form.


New Group Sizes - Effective January 1, 2016

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New group sizes will be defined as:

Small Group = 100 or fewer full-time equivalent eligible employees

Large Group = more than 100 full-time equivalent eligible employees