Medical Forms | California

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Small Group Health

 

Following are forms for application:

Medical Census - Employee List for Application

   Form in Excel

   Form in PDF

Broker of Record Change Form

 

Claim Forms

Aflac Accident Claim Form

Informational Materials

Small Group Underwriting Guidelines (2 to 50 employees)

StartUp Group Guidelines

 

Large Group Information

51+ Groups Information Gathering Checklist

 

Pink Payroll Internal Docs

JC LISI Team Contact Info