Below are your forms for download. You may download each form individually, or the Form Package, which contains all of the forms. You will need the free Adobe Acrobat Reader to open the Benefit Plan forms. Click here to get Acrobat Reader.

Please note that the forms can be large in size and may require extended download times at slower connection speeds.

Please note that you may only use the forms on this page
if you live in one of the following states:
AK, NV, WA or the District of Columbia (DC)

• Form Package (1.1 MB)
• Individual Forms
  • Enrollment
    • Enrollment Form
    • Enrollment Instructions
    • Bank Draft Authorization
  • Group Life Insurance Plan
  • Group Supplemental Hospital Indemnity Basic Plan
  • Group Supplemental Hospital Indemnity Premier Plan
  • Mid Med Medical Plan - Level One
  • Mid Med Medical Plan - Level Two
  • Dental Insurance Plan
  • Short-Term Disability Income Plan
  • Prescription Drug Plan
  • EyeMed Vision Care Plan
  • Group Critical Illness Plan
    • Critical Illness Plan Application
  • Group Accident Insurance Plan
  • Short-Term Major Medical Plan
  • Individual Major Medical

Area 3