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

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. TX Dental PPO & Vision Employer Application Word | PDF
3. IndemnityPlus & Vision Employer Application Word | PDF
4. Topaz Dental PPO & Vision Employer Application Word | PDF
5. Topaz Dental Indemnity & Vision Employer Application Word | PDF

Employee Forms

1. Dental Group Roster (to enroll more than one employee) Word | Excel
2. Utah Universal Small Business Employee application PDF
3. English Dental Only Enrollment Form Online | Word | PDF
   
4. Spanish Dental Only Enrollment Form Word | PDF
5. English Dental/Vision Enrollment Form Online | Word | PDF
6. Spanish Dental/Vision Enrollment Form Word | PDF
   
7. Affidavit of Domestic Partnership Form Word | PDF
8. 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. Utah Universal Small Business Employee application PDF
5. Idaho Universal Enrollment Form (for all medical plans) Online | PDF
6. Group Medical Claim Form PDF
7. Caremark Mail Order Form PDF
8. View a Current Drug List PDF
   
9. 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 Enrollment Form (for all medical plans) Online | PDF
5. Utah Universal Small Business Employee application PDF
6. Group Medical Claim Form PDF
7. Caremark Mail Order Form PDF
8. View a Current Drug List PDF
   
9. 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

1. English Enrollment Card Online | Word | PDF
2. Spanish Enrollment Card Word | PDF
3. Utah Universal Small Business Employee application PDF
4. Vision Indemnity 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. Change of Beneficiary Word | PDF
5. Employee Death Benefits Claim Form PDF
6. Dependents Death Benefits Claim Form PDF
7. AD&D Claim Form PDF
8. Accelerated Benefits Claim Form PDF
9. Waiver of Premium Claim Form PDF