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Frequently Used Forms
LIFE & ANNUITY
HEALTH
INDIVIDUAL & FAMILY
LARGE GROUP
SMALL GROUP
I. LIFE INSURANCE AND ANNUITY FORMS
Banner Life
Multipurpose Life Insurance Change Form
First Colony Life (Genworth Financial)
Life Insurance Auto Draft Form
Multipurpose Life Insurance Change Form
Multipurpose Annuity Change Form
New York Life
New York Life Check-o-Matic Form
New York Life Change of Beneficiary Form
New York Life Transfer of Ownership Form
New York Life Trust as Beneficiary and/or Owner Form
New York Life Full Surrender Form
New York Life Partial Withdrawal Form
New York Life Election of Premium Offset Form (POP)
New York Life Variable Annuity Asset Allocation and Transfer Form
New York Life Variable Life Asset Allocation and Transfer Form
USFL
Multipurpose Service form for Life Insurance Policies
II. SMALL GROUP HEALTH FORMS
AETNA
Employee Application and Change Request Form
Blue Cross
Employee Enrollment Application for Benefits Plan (New Groups ONLY)
Employee Enrollment Application for Employee Elect Plan (New Groups ONLY)
Employee Enrollment Application (Existing Groups ONLY)
Employee Change of Coverage Request Form
Blue Shield
Employee Enrollment Application (English)
Employee Enrollment Application (Spanish)
Employee Health Statement (Required with all applications for groups of 2-14 ONLY)
Employee Change Request Form (English)
Employee Change Request Form (Spanish)
California Choice (CALCHOICE)
Employee Enrollment Application (English)
Employee Enrollment Application (Spanish)
Salud Enrollment Application (English)
Salud Enrollment Application (Spanish)
Employee Change Request Form (English)
Employee Change Request Form (Spanish)
Kaiser
Employee Enrollment Application (English)
Employee Enrollment Application (Spanish)
Employee Account Change Form (English)
Employee Account Change Form (Spanish)
III. LARGE GROUP HEALTH FORMS
Blue Cross
Employee Enrollment Application (English)
Employee Enrollment Application (Spanish)
Blue Shield
Employee Enrollment Application (English)
Employee Enrollment Application (Spanish)
California Choice (CALCHOICE)
Employee Enrollment Application (English)
Employee Enrollment Application (Spanish)
Salud Enrollment Application (English)
Salud Enrollment Application (Spanish)
Employee Health Questionnaire (English)-MUST BE COMPLETED BY ALL ENROLLEES
Employee Health Questionnaire (Spanish)-MUST BE COMPLETED BY ALL ENROLLEES
Employee Change Request Form (English)
Employee Change Request Form (Spanish)
Kaiser
Employee Enrollment Application and Change Request Form (English)
Employee Enrollment Applications and Change Request Form (Spanish)
IV. INDIVIDUAL HEALTH INFORMATION AND FORMS
Blue Cross
To enroll online, click here
Individual and Family Enrollment Application (English)
Individual and Family Enrollment Application (Spanish)
Individual and Family Change of Coverage Request Form
Plan Options and Benefits
Monthly Rates for Individual and Family Medical Plans (Orange County)
Monthly Rates for Individual and Family Medical Plans (Los Angeles County)
Blue Shield
Individual and Family Enrollment Application
Individual and Family Plan Change Request Form (changes that require underwriting)
Individual and Family Plan Change Request Form (changes that DO NOT require underwriting)
Kaiser
Individual and Family Enrollment Application
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