FORMS
- Declaration of Disability for Over-Age Dependents
- Declination of Coverage
- Domestic Partner
- Electronic Funds Transfer
- One Time E-Payment Authorization
- Enrollment/Change Form
- Group Size Attestation
- Health Information Release
- HSA Authorization
- Model notice of cancellation
- Rate Filing Disclosure - Individual Group
- Rate Filing Disclosure - Small Group
- Rate Filing Disclosure - Large Group
- Rate Filing Disclosure - Individual (Spanish)
- Rate Filing Disclosure - Small Group (Spanish)
- Rate Filing Disclosure - Large Group (Spanish)
- Request for Termination Review Form
- Supply Requisition
- Termination Form
Member Benefit Information
- Advantage Referral
- Behavioral Health: Optum
- Complementary and Alternative Medicine (CAM)
- Digital Resources: Apps and Mobile
- Emergency Travel Assistance
- Health Plan Basics: WHA FAQs
- HSA: Winning With HealthEquity
- Livongo for Hypertension Flyer
- Manage Your HSA-Compatible HDHP
- Manage Your HSA-Compatible HDHP w/ HealthEquity
- Preferred Drug List (large group plans)
- Preferred Drug List (individuals and small group plans)
- Prescription Benefits
- Wellness Brochure