WHA
  • Our Plans
    Shop Plans
    • Individual or Family
    • Medicare Advantage
    • Small Business
    • Large Business
    Compare Plans
    • Covered by My Employer
    • Agent or Broker
    • Enrollment Counselor
  • Search Doctors
    Tools
    • Find a Doctor
    • View My Doctor
    • Change My Doctor
    Resources
    • Provider Network
    • Advantage Referral
    • Partners in Care
    • Virtual Visits
    • Connect with My Doctor
    • Timely Access to Care
    • Authorization FAQs
    • Verification Process
  • Pharmacy
    Prescription Coverage
    • Pharmacy Overview
    • Pharmaceutical Management
    • Manage My Prescriptions
  • MyWHA Group
    eBill: Billing and Payments
    • Account Activity
    • Invoice & Payment History
    Group Administration
    • Add New Employee
    • Update Existing Enrollment
    • Terminate Member
    • View Member Roster
    • Order Member ID Cards
    Documents
    • Download 1095C Data
    • Copayment Summaries
    • Evidence of Coverage(s)
    • Summary of Benefits & Coverage
  • Health & Wellness
    Healthy Living
    • Health & Wellness Overview
    • Adolescent Wellness
    • Diabetes Wellness
    • Disease Management
    • Heart Health
    • Infant Wellness
    • Men's Wellness
    • Mental Health
    • Preventive Health
    • Women's Wellness
    Resources
    • Gym Discounts
    • Rights & Responsibilities
    • MyWHA Wellness
    • Nurse24
    • Recipe Center
    • Stop Smoking
    • Wellness Classes
    • CommunityFIT
  • Other Sites
    • Member
    • Medicare
    • Employer
    • Broker
    • Provider
  • Login | Register
Start here: LOGIN
Employer Downloads banner image

Employer Downloads

  1. Home page
  2. /Employers
  3. /Employer Downloads

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
  • Request for Termination Review Form
  • Supply Requisition
  • Termination Form

DOWNLOADS

  • Advantage Referral
  • Assist America
  • Health and Wellness Overview
  • Health Plan Basics
 
  • Nurse24
  • On-the-Go Access
  • Sales Brochure

MyWHA Group

Employer Home
Sign up for MyWHA Group Copayment Summaries Evidence of Coverage Summary of Benefits & Coverage

Member Resources
  • Getting Started
  • Find a Doctor
  • Mobile App
  • Register for MyWHA
Quick Help
  • Contact Us
  • FAQs
  • Send us Feedback
  • Shop Plans
About
  • About WHA
  • Blog
  • Giving Back
  • Careers
Other Sites
  • Members
  • Broker
  • CalPERS
  • Employers
  • Providers
  • Grievance Form
  • Legal
  • Privacy
  • Terms of Use
  • Non-Discrimination
  • العربية
  • 中文
  • 日本語
  • Hmong
  • 한국어
  • русский
  • Tagalog
  • այերեն
  • ارسی
  • Khmer
  • Lao
  • Español
  • Tiếng Việt
  • ภาษาไทย
  • हिंदी
  • ខ្មែរ

Copyright © 2021 Western Health Advantage. All Rights Reserved.

WHA is closely monitoring the Coronavirus Disease 2019 (COVID-19). Learn more about COVID-19