Forms

Need to submit a claim? You'll find the forms you need right here. Simply fill them out and return them as directed via email!

Underwriting

New Case Submission Checklist

New Case Transmittal

Minimum Plan Document Requirements

Disclosure Statement

Agent Appointment Data Sheet

Request for Stop Loss Quotation

Claims

Monthly Aggregate Stop Loss

Specific Request Form

Aggregate Request Form

Specific Loss Eligibility Sheet

Specific Excess Risk Payment Sheet

Notification of Catastrophic Claim

Premium Accounting

Premium Remittance

Other Forms

HIPAA Business Associate Agreement