Forms

Broker Authorization Forms

Group Underwriting Forms

Prescription Claims Forms

Claims Forms

Eligibility Certification Forms

Medical & Dental Enrollment Forms for Groups with 101 or more full-time Equivalent Employees

Forms for Small Groups (100 or fewer), Individuals, and Families are available in Univera on Demand (Login Required)Univera on Demand

  1. Choose application based on whether the product requires a primary care physician
  2. Select the plans your group offers from the dropdown(s) under Medical and Dental Plan Selection

Additional Enrollment Forms

Medicare Enrollment Forms