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 Benefit populates all of the following enrollment forms:
Minnesota
Blue Cross: small group, large group
PreferredOne: small group, large group
Medica: small group, large group
HealthPartners: small group, large group
Delta Dental: small group, large group
Wisconsin
State required small group enrollment and health statement form
Indiana
Aetna: small group
Anthem: small group
Humana: small group, large group
UHC: small group, large group
Illinois
United Healthcare: small group, large group
Humana: small group, large group
Aetna: small group, large group
Blue Cross: small group, large group
Unicare: small group, large group
Coventry: small group
Arizona
Aetna: small group
Humana: small group
UHC: small group
Blue Cross: small group
California
Aetna: small group
Blue Cross: small group, large group
Florida
Aetna: small group
Coventry/Vist: small group
Humana: small group
Iowa
Universal Application
Kansas
Aetna: small group
Humana: small group, large group
UHC: small group, large group
Blue Cross KC: small group, large group
Kentucky
Anthem: small group
Humana: small group, large group
Michigan
Aetna: small group
Humana: small group, large group
Missouri
Aetna: small group
Anthem: small group
Humana: small group, large group
UHC: small group
Blue Cross KC: small group, large group
Ohio
Aetna: small group
Anthem: small group
Humana: small group, large group
UHC: small group
Texas
Aetna: small group
Blue Cross: small group
Humana: small group
UHC: small group
HSA Enrollment
Blue Cross of Minnesota
Generic enrollment form
UBenefit Generic Enrollment Form
(with and without health statement)
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