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Client Forms 

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

HIPPAA Privacy Policy 

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, salary updates or contact information changes. 

FormFire Instructions

For existing group clients, if an employee needs to make changes to their benefit elections, they can log into FormFire and update from there. They will need to call in or email us to obtain the required Employer Code.

Group Census

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

Individual and Medicare 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.

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