Forms

Ease of Administration

We have compiled a list of the forms and items you may need when working with clients to offer the best Significa PPO plan options for their health care coverage needs.

Feel free to download these forms as you need them. If you have any questions or need a printed supply of the
Marketing Materials listed, please do not hesitate to contact us at 1-800-796-7460.

Getting Started
	AGENT APPOINTMENT KIT
	FIELD UNDERWRITING GUIDELINES
	QUOTE REQUEST FORM
	NEW GROUP CHECKLIST
	ADDITIONAL ADMINISTRATIVE SERVICES
Applications
	EMPLOYER RISK APPRAISAL
	EMPLOYER APPLICATION (AZ)
	EMPLOYEE APPLICATION (2-25)
	EMPLOYEE APPLICATION (26+)
Marketing Materials
	PPO OPTIONS MATRIX
	QHDHP PPO OPTIONS MATRIX
	POS OPTIONS MATRIX
	SIGNIFICA BROCHURE
	SIGNIFICA AT A GLANCE BROCHURE
	MYHEALTH
	EXCLUSIONS
Other Forms
	CLAIM FORM
	CHANGE/TERM FORM