BEST Life Forms

Please make a selection from the menu below:

1. Generic Forms and Notices
2. Dental
3. Medical
4. Vision
5. Group Term Life
6. Short Term Disability

Employee Forms and Notices

1. Continuation of Coverage for Disabled Dependents Form PDF
2. Language Assistance Program Notice (for CA groups) PDF
3. HIPAA Notice English | Spanish
4. Termination Form (for terming an employee's coverage) Word | PDF
5. COBRA Form PDF

DENTAL

Employer Applications

1. Dental PPO & Vision Employer Application Word | PDF
2. CA Dental PPO & Vision Employer Application Word | PDF
3. TX Dental PPO & Vision Employer Application Word | PDF
4. IndemnityPlus & Vision Employer Application Word | PDF
5. CA IndemnityPlus & Vision Employer Application Word | PDF
6. Topaz Dental PPO & Vision Employer Application Word | PDF
7. Topaz Dental Indemnity & Vision Employer Application Word | PDF

Employee Forms

Please note that these forms include the new dependent age limit that went into effect for new business on October 1, 2010. For in-force groups who choose to implement the new age limit at renewal, please visit www.bestlife.com/forms_employers.html.

1. Dental Group Roster (to enroll more than one employee) Word | Excel
2. CA English Dental Only Enrolmlent Form Word | PDF
   
3. CA Spanish Dental Only Enrollment Form Word | PDF
4. CA English Dental/Vision Enrollment Form Word | PDF
5. CA Spanish Dental/Vision Enrollment Form Word | PDF
6. Ohio Uniform Small Group Employee Application PDF
7. Utah Universal Small Business Employee Application PDF
8. English Dental Only Enrollment Form Online | Word | PDF
9. Spanish Dental Only Enrollment Form Word | PDF
10. English Dental/Vision Enrollment Form Online | Word | PDF
11. Spanish Dental/Vision Enrollment Form Word | PDF
12. Affidavit of Domestic Partnership Form Word | PDF
13. Dental Claim Form PDF

MEDICAL

Employer Applications

1. National Health Solutions II Employer Application Word | PDF
2. TX Health Solutions II Employer Application Word | PDF
3. National High Deductible Health Plan Employer Application Word | PDF
4. TX High Deductible Health Plan Employer Application Word | PDF

Health Solutions II - Medical Co-pay Employee Forms

1. Health Solutions II Enrollment Form (National) Online | Word | PDF
2. Health Solutions II Enrollment Form (Texas) Online | Word | PDF
3. Health Solutions II Enrollment Form (Arizona) PDF
4. Idaho Universal Employee Enrollment Form Online | PDF
5. Illinois Standard Health Application (for employees) PDF
6. Ohio Uniform Small Group Employee Application PDF
7. Utah Universal Small Business Employee Application Online | PDF
8. Group Medical Claim Form PDF
9. CVS Caremark Mail Order Form PDF
10. View a Current Drug List PDF
    
11. CVS Caremark Prescription Drug Claim Form PDF
    

Health Solutions I - HDHP Employee Forms

1. HDHP Employee Enrollment Form Online | Word | PDF
2. HDHP Employee Enrollment Form (Texas) Online | Word | PDF
3. HDHP Employee Enrollment Form (Arizona) PDF
4. Idaho Universal Employee Enrollment Form Online | PDF
5. Illinois Standard Health Application (for employees) PDF
6. Ohio Uniform Small Group Employee Application PDF
7. Utah Universal Small Business Employee application Online | PDF
8. Group Medical Claim Form PDF
9. CVS Caremark Mail Order Form PDF
10. View a Current Drug List PDF
    
11. HDHP Prescription Drug Claim Form PDF

VISION

Employer Applications

1. Access Vision Employer Application Word | PDF
2. Vision PPO Employer Application Word | PDF

Employee Forms

Please note that these forms include the new dependent age limit that went into effect for new business on October 1, 2010. For in-force groups who choose to implement the new age limit at renewal, please visit www.bestlife.com/forms_employers.html.

1. English Enrollment Card Online | Word | PDF
2. Spanish Enrollment Card Word | PDF
3. Ohio Uniform Small Group Employee Application PDF
4. Utah Universal Small Business Employee Application PDF
5. Vision Indemnity Claim Form PDF
6. Vision PPO Out of Network Claim Form PDF
   

GROUP TERM LIFE

Employer Applications

1. Gold, Silver and Bronze Life Employer Application Word | PDF
2. Gold, Silver and Bronze Life Employer Application (Texas) Word | PDF
3. Gold, Silver and Bronze Life Employer Application (Ohio) Word | PDF
4. Essential Group Life Insurance Employer Application Word | PDF

Employee Forms

1. Gold, Silver and Bronze Life Enrollment Form Word | PDF
2. Essential Life Enrollment Form Word | PDF
3. Group Term Life Roster (to enroll more than one employee) PDF
   
4. Ohio Uniform Small Group Employee Application PDF
5. Change of Beneficiary Word | PDF
6. Employee Death Benefits Claim Form PDF
7. Dependents Death Benefits Claim Form PDF
8. AD&D Claim Form PDF
9. Accelerated Benefits Claim Form PDF
10. Waiver of Premium Claim Form PDF

 

SHORT TERM DISABILITY

Employer Applications

• National Employer Application Word | PDF
• Group Roster (for groups with no late entrants) Word | PDF | Excel

Employee Forms

• Short Term Disability Enrollment Form Word | PDF
• Short Term Disability Enrollment Form (Kentucky) Word | PDF
• Illinois Standard Health Application (for employees applying for medical as well) PDF
• STD Waiver of Coverage PDF
• STD Claim Form Word | PDF