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.

Applications
	ENROLLMENT APPLICATION
	SUPPLEMENTAL DEPENDENT APP
	DISABLED DEPENDENT APPLICATION
Marketing Materials
	SIGNIFICA BROCHURE
	SIGNIFICA AT A GLANCE BROCHURE
	MYHEALTH
	EXCLUSIONS
Other Forms
	BENEFICIARY CHANGE FORM
	CLAIM FORM
	CHANGE/TERM FORM
	LIFE ACCIDENTAL DEATH AND DISMEMBERMENT CLAIM FORM