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Client Forms 

Navigate to your selected form to complete and submit it to us. 

These are fillable PDF Forms, some of which may require a signature.

Completed forms can be sent to or faxed to 740-369-1556.

Group Benefits - General Forms 

Group Change 

This form is for any group changes you have to report, such as new hires, terminations, or contact information changes. 

Group Census

For new group clients needing to send in employee census data for quoting.

Employee Waiver 

For existing group clients, if an employee needs to waive benefits, they can complete and return this form. 

Individual Client Forms 

Medicare Drug List

For new and existing Medicare clients. We collect this information to help guide your plan selection to best cover your medications. 

This form is required for new and returning Medicare clients. This form is mandated by the Centers for Medicare and Medicaid Services (CMS) and is required for all Medicare appointments. 

Marketplace Consent

Marketplace consent is required for new and returning individual marketplace clients.

Client Change Form

For existing clients to report changes in address, contact information, dependent information, etc. 

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