Forms | Amwins Connect Administrators

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Fully-Insured

Group Application

Enrollment Form

Spanish Employee Election Form (with Addendum)

Client Online Enrollment Agreement

Small Group Checklist

Small Group Census Template

Confirmation of Full-Time Student Status

Group Insurance Ineligibility Listing

Small Group Termination Request

Large Group Census Template

Large Group Screening Form

Self-Funded

HealthyAdvantage Checklist

Self-Funding 101

HealthyAdvantage Plan Services Agreement

Domestic Partner Affidavit

Amwins Connect Administrators Health Plans Enrollment Form

Amwins Connect Administrators Health Plans Late Letter to Employees

Medical Claims Form

New York Surcharge Form

Brokers

Anthem Individual and Group BOR

General Carrier Sample

Kaiser Permanente MAS – BOR Authorization

Online Enrollment Agreement

Principal Outside Party Agreement

UNUM TPA Sample Transfer Letter

Broker-Agency GA OLE Agreement