Forms

Ease of Administration

We have compiled a list of the forms and items you may need when administering Significa PPO plan options for your employees.

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
	EMPLOYER RISK APPRAISAL
	EMPLOYER APPLICATION (AZ)
Applications
	EMPLOYEE APPLICATION (2-25)
	EMPLOYEE APPLICATION (26+)
	SUPPLEMENTAL DEPENDENT APP
	DISABLED DEPENDENT FORM
Marketing Materials
	SIGNIFICA BROCHURE
	SIGNIFICA AT A GLANCE BROCHURE
	MYHEALTH
	EXCLUSIONS
Other Forms
	CLAIM FORM
	CHANGE/TERM FORM