Myriad Benefits, LLC. ~ Unique Solutions for Health Insurance

Online Benefits

Customer Hotline

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Group Forms

Individual Forms

Large Group Application with Health Statement

Application for Medium/Large Employer Coverage (51 or more)

Large Group Questionnaire for New Groups (51 or more)

Application for Small Employer Coverage (2-50 Employees)

Group Questionnaire for New Groups (2-50 employees)

Small Group Enrollment Application

Employee Waiver of Health Care Coverage

Preferred Dental Brochure

Voluntary Dental Sales Literature

Voluntary Dental Application (Employer)

Group Stand Alone Dental Application

Deductible Dental Brochure / Incentive Dental Brochure

Vision Service Plan Options

Patient Questionnaire Claim Form

Prescription Drug Reimbursement Form

BC Large Group w/o Health Statement

Large Group Health/Dental Application w /o Health Statement

Large Group Health/Dental Enrollment Application with Health Statement

Cover Sheet and Individual Application

Short Term Brochure and Application

Short Term Rates & Benefits

Transfer Application

Individual Application Checklist

Personal Blue Sales Literature

HSA Blue Sales Literature

Individual Health Insurance Coverage Change Form

Dental PPO Application (Individual)

Dental Blue PPO Sales Literature and Application (Individual)

Dental Blue PPO Rates (Individual)

Medicare Advantage Plans Enrollment Form (Seniors)

Essential Blue Plus PPO Brochure

Authorization Agreement for Prearranged Payments

Essential Blue Basic PPO Brochure

Patient Questionnaire Claim Form

Prescription Drug Reimbursement Form

Medicare Supplement Application - Plans A,C, & F

Medicare Supplement Application - Plan J

Simply Blue Brochure

Latitude Brochure & Talking Points

Individual Program Premiums - all levels

Simply Blue Premiums - all levels