Plan document library
Plan summaries and rates, and group application forms in downloadable .PDF format.
Voluntary Group Plans
Voluntary group plans
Group application form [9050, 9060 & 9070]
Fillable group application form for voluntary group plans 9050, 9060 & 9070
Voluntary group plans
Group application form [602 & 603]
Fillable group application form for ACA group plans 602 & 603
Voluntary group plans
Enrollment/change form
Enrollment and change form for primary subscribers and dependents in group plans.
Pooled group plans
Group application form
Fillable group application form for all pooled group plans [9000, 9010, 9020, 2500 & 2525]
Pooled group plans
Enrollment/change form
Enrollment and change form for primary subscribers and dependents in group plans.
SD Retailers Association plans
SDRA plans [8010, 8012, 8013 & 8015]
Summary of benefits and rates for 2020
SD Retailers Association plans
Group application form
Fillable group application form for all SDRA group plans [8010, 8012, 8013 & 8015]
SD Retailers Association plans
Enrollment/change form
Enrollment and change form for primary subscribers and dependents in group plans.
Individual & family plans
Individual & Family Plans [1040, 502 & 503]
Summary of benefits and rates for 2020
Individual & family plans
Enrollment form
Fillable enrollment form for all Individual & family plans [1040, 502 & 503]
