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. AZ & NV Dental PPO & Vision Employer Application Word | PDF
3. CA Dental PPO & Vision Employer Application Word | PDF
4. TX Dental PPO & Vision Employer Application Word | PDF
5. IndemnityPlus & Vision Employer Application Word | PDF
6. AZ & NV IndemnityPlus & Vision Employer Application Word | PDF
7. CA IndemnityPlus & Vision Employer Application Word | PDF
8. Topaz Dental PPO & Vision Employer Application Word | PDF
9. Topaz Dental Indemnity & Vision Employer Application Word | PDF

Employee Forms

1. Dental Group Roster (to enroll more than one employee) Word | PDF | Excel
2. CA English Dental Only Enrollment 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. Affidavit of Domestic Partnership Form - CA PDF
14. Dental Claim Form PDF

Medical

Employer Applications

1. National High Deductible Health Plan Employer Application Word | PDF
2. TX High Deductible Health Plan Employer Application Word | PDF
   

Health Solutions - HDHP Employee Forms

1. National HDHP Employee Enrollment Form Online | Word | PDF
2. Arizona HDHP Employee Enrollment Form PDF
3. Idaho Universal Employee Enrollment Form Online | PDF
4. Illinois Standard Health Application (for employees) PDF
5. Ohio Uniform Small Group Employee Application PDF
6. Texas HDHP Employee Enrollment Form Online | Word | 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 E-Claim Process PDF
12. HDHP Prescription Drug Claim Form (non-participating pharmacy) PDF

Vision

Employer Applications

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

Employee Forms

1. Vision Group Roster (to enroll more than one employee) Word | PDF | Excel
2. English Enrollment Card Online | Word | PDF
3. Spanish Enrollment Card Word | PDF
4. Ohio Uniform Small Group Employee Application PDF
5. Utah Universal Small Business Employee Application PDF
6. Vision Indemnity Claim Form PDF
7. Vision PPO Out of Network Claim Form PDF
   

Group Term Life

Employer Applications

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

Employee Forms

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

Short Term Disability

Employer Applications

• National Employer Application Word | PDF

Employee Forms

• Group Roster (for groups with no late entrants) Word | PDF | Excel
• Short Term Disability Enrollment Form Word | PDF
• Kentucky Short Term Disability Enrollment Form Word | PDF
• Illinois Standard Health Application (for employees applying for medical as well) PDF
• STD Waiver of Coverage PDF
• STD Claim Form Word | PDF